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  5. SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.

SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.

Company Details

Entity Name: SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 06 Nov 2001 (23 years ago)
Document Number: P01000106946
FEI/EIN Number 651153590
Address: 4054 BEAVER LANE, #7, PORT CHARLOTTE, FL, 33952
Mail Address: P.O. BOX 510460, PUNTA GORDA, FL, 33951
ZIP code: 33952
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1730161993 2005-11-15 2020-08-22 PO BOX 510460, PUNTA GORDA, FL, 339510460, US 13695 US HIGHWAY 1, SEBASTIAN RIVER MEDICAL CENTER, SEBASTIAN, FL, 329583230, US

Contacts
Phone +1 941-575-8227
Fax 9415751879
Phone +1 772-581-2080
Fax 7725812081

Authorized person
Name DR. ANTHONY POLLIZZI
Role PRESIDENT
Phone 9415758227

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers
Issuer FL BLUE SHIELD PROV NUMBE
Number 34240
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2017 651153590 2018-07-10 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-10
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2016 651153590 2017-11-28 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Signature of
Role Plan administrator
Date 2017-11-28
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-11-28
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2015 651153590 2016-08-04 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Signature of
Role Plan administrator
Date 2016-08-04
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2014 651153590 2015-10-13 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing JOHN O. WUNDER
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2013 651153590 2014-07-29 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2012 651153590 2013-07-31 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Signature of
Role Plan administrator
Date 2013-07-31
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-31
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2011 651153590 2012-07-31 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Plan administrator’s name and address
Administrator’s EIN 651153590
Plan administrator’s name SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948
Administrator’s telephone number 9416251951

Signature of
Role Plan administrator
Date 2012-07-31
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-31
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2010 651153590 2011-08-29 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Plan administrator’s name and address
Administrator’s EIN 651153590
Plan administrator’s name SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948
Administrator’s telephone number 9416251951

Signature of
Role Plan administrator
Date 2011-08-29
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-08-29
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2009 651153590 2010-10-14 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 6
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Plan administrator’s name and address
Administrator’s EIN 651153590
Plan administrator’s name SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address P.O. BOX 510626, PUNTA GORDA, FL, 339510626
Administrator’s telephone number 9416251951

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-14
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES P.A. 401K PROFIT SHARING PLAN & TRUST 2009 651153590 2010-10-15 SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 9416251951
Plan sponsor’s address 17801 MURDOCK CIRCLE, SUITE C, PORT CHARLOTTE, FL, 33948

Plan administrator’s name and address
Administrator’s EIN 651153590
Plan administrator’s name SEBASTIAN RIVER ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address P.O. BOX 510626, PUNTA GORDA, FL, 339510626
Administrator’s telephone number 9416251951

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-15
Name of individual signing ACHILLES STACHTIARIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HOLMES DAVID AEsq. Agent FARR LAW FIRM, PUNTA GORDA, FL, 33950

President

Name Role Address
POLLIZZI ANTHONY President P.O. BOX 510460, PUNTA GORDA, FL, 33951

Vice President

Name Role Address
FORENSKY JAMES P Vice President P. O. BOX 510460, PUNTA GORDA, FL, 33951

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2018-12-31 No data No data

Related by officers

POLLIZZI ANTHONY

PEACE RIVER PROFESSIONAL CONDOMINIUM ASSOCIATION, INC. PAIN MEDICINE CONSULTANTS OF FLORIDA, P.A. PEACE RIVER ANESTHESIOLOGY ASSOCIATES, P.A. POLLIZZI AND FORENSKY ASSOCIATES, INC. ENGLEWOOD ANESTHESIOLOGY ASSOCIATES, P.A. DAVENPORT ANESTHESIOLOGY ASSOCIATES, P.A.

FORENSKY JAMES P

PAIN MEDICINE CONSULTANTS OF FLORIDA, P.A. PEACE RIVER ANESTHESIOLOGY ASSOCIATES, P.A.

HOLMES DAVID AEsq.

ONE AND DONE PARTNERS, LLLP PJF INVESTMENTS, LLC MINOOKA HOLDINGS, LLC MILLENNIUM PHYSICIAN GROUP, LLC GECKO COLORADO HOLDINGS, LLC BOHAGER PROPERTIES, LLC BECKMANN HOLDINGS, LLC M & R FRIENDSHIP ROAD, LLC M & R COFFEY FAMILY LIMITED PARTNERSHIP, LLLP M & R COFFEY INVESTMENTS, LLC

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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