| Entity Name: | B.G. YANGCO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Dec 2000 (24 years ago) |
| Document Number: | P00000113718 |
| FEI/EIN Number | 593687639 |
| Mail Address: | PO BOX 152495, TAMPA, FL, 33684 |
| Address: | C/O BIENVENIDO G. YANGCO, M.D., 4620 N HABANA AVE, STE 203, TAMPA, FL, 33614 |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841568714 | 2011-12-07 | 2011-12-07 | 4620 N HABANA AVE, SUITE 203, TAMPA, FL, 336147107, US | 4620 N HABANA AVE, SUITE 203, TAMPA, FL, 336147107, US | |||||||||||||||||||||
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| Phone | +1 813-875-4375 |
| Fax | 8138754376 |
Authorized person
| Name | JAD YANGCO |
| Role | OFFICE MANAGER |
| Phone | 8138751024 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 038840800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STULL JEFFREY R | Agent | 602 SOUTH BLVD., TAMPA, FL, 33606 |
| Name | Role | Address |
|---|---|---|
| YANGCO BIENVENIDO G | Director | 4620 N HABANA AVE, STE 203, TAMPA, FL, 33614 |
| Name | Role | Address |
|---|---|---|
| YANGCO JADWIGA K | Manager | 4620 N HABANA AVE., STE 203, TAMPA, FL, 33614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
