| Entity Name: | JAMES G. SCELFO, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Mar 2002 (23 years ago) |
| Document Number: | P02000031535 |
| FEI/EIN Number | 010634214 |
| Mail Address: | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Address: | 602 FRONT STREET, CELEBRATION, FL, 34747, UN |
| ZIP code: | 34747 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144215757 | 2005-09-20 | 2008-04-11 | 602 FRONT ST, CELEBRATION, FL, 347474675, US | 602 FRONT ST, CELEBRATION, FL, 347474675, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-566-2454 |
| Fax | 4075662572 |
Authorized person
| Name | MR. JAMES GREGORY SCELFO |
| Role | OWNER |
| Phone | 4075662454 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME79384 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | 13631 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | Agent | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | President | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | Vice President | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | Secretary | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | Treasurer | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Name | Role | Address |
|---|---|---|
| SCELFO JAMES G | Director | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| SCELFO BAE | Director | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08120700063 | PERSONALIZED PRIMARY CARE | EXPIRED | 2008-04-29 | 2013-12-31 | No data | 602 FRONT STREET, CELEBRATION, FL, 34747 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2010-03-11 | No data | No data |
| REINSTATEMENT | 2004-01-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
