| Entity Name: | DUNNELLON PODIATRY CENTER, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Nov 2000 (24 years ago) |
| Document Number: | P00000105157 |
| FEI/EIN Number | 651062763 |
| Address: | 11786 CEDAR STREET, DUNNELLON, FL, 34431 |
| Mail Address: | POST OFFICE BOX 2633, DUNNELLON, FL, 34430 |
| ZIP code: | 34431 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194742148 | 2006-07-16 | 2007-12-12 | PO BOX 2633, DUNNELLON PODIATRY CENTER PA, DUNNELLON, FL, 34430, US | 11786 CEDAR STREET, DUNNELLON PODIATRY CENTER PA, DUNNELLON, FL, 34431, US | |||||||||||||||||||||||||
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| Phone | +1 352-489-6621 |
| Fax | 3524896920 |
Authorized person
| Name | STACY LYNN WITFILL |
| Role | OWNER PODIATRIST |
| Phone | 3524896621 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | P02759 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 65619 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WITFILL STACY | Agent | 3614 N Pine Valley Loop, Lecanto, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| WITFILL STACY | Director | 3614 N Pine Valley Loop, Lecanto, FL, 34461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-24 | 3614 N Pine Valley Loop, Lecanto, FL 34461 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-04-19 | 11786 CEDAR STREET, DUNNELLON, FL 34431 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-29 |
| ANNUAL REPORT | 2023-02-10 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-26 |
| ANNUAL REPORT | 2020-05-06 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-03-21 |
| ANNUAL REPORT | 2017-02-24 |
| ANNUAL REPORT | 2016-03-24 |
| ANNUAL REPORT | 2015-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
