| Entity Name: | CITRUS ORTHOPAEDIC & JOINT INSTITUTE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Mar 2001 (24 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 03 Oct 2021 (3 years ago) |
| Document Number: | P01000026247 |
| FEI/EIN Number | 593693151 |
| Address: | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Mail Address: | PO BOX 1990, CRYSTAL RIVER, FL, 34423 |
| ZIP code: | 34461 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1275668063 | 2007-02-22 | 2015-04-27 | PO BOX 1990, CRYSTAL RIVER, FL, 344231990, US | 950 N AVALON WAY, LECANTO, FL, 344616004, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-746-2663 |
| Fax | 3527466907 |
Authorized person
| Name | DR. ANDREW J PETRELLA |
| Role | OWNER |
| Phone | 3527462663 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | ME0074278 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| License Number | ME0080012 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | PO0002716 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT20489 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT8397 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT3425 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363A00000X - Physician Assistant |
| License Number | PA9108675 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA3291 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA9101478 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| License Number | PA3291 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| License Number | PA9101478 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DA2404 |
| State | FL |
| Issuer | MEDICAID |
| Number | 273441900 |
| State | FL |
| Issuer | BCBS FLA |
| Number | 94997 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PETRELLA JENNIFER | Agent | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| PETRELLA ANDREW J | President | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| PETRELLA JENNIFER D | Secretary | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| KAUFFMAN STEPHEN C | Treasurer | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| Keen Christopher | Vice President | 950 N AVALON WAY, LECANTO, FL, 34461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-10-03 | PETRELLA, JENNIFER | No data |
| REINSTATEMENT | 2021-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REINSTATEMENT | 2014-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-01-04 | 950 N AVALON WAY, LECANTO, FL 34461 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-07-03 | 950 N AVALON WAY, LECANTO, FL 34461 | No data |
| CHANGE OF MAILING ADDRESS | 2004-01-20 | 950 N AVALON WAY, LECANTO, FL 34461 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-03-31 |
| REINSTATEMENT | 2021-10-03 |
| ANNUAL REPORT | 2020-07-20 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-02-16 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-02-02 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
