| Entity Name: | CROSS CREEK MEDICAL,PA |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
CROSS CREEK MEDICAL,PA is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 30 May 2002 (23 years ago) |
| Document Number: | P02000060008 |
| FEI/EIN Number |
141852106
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1381 CROSS CREEK CIRCLE, #A, TALLAHASSEE, FL, 32301 |
| Mail Address: | 1381 CROSS CREEK CIRCLE, #A, TALLAHASSEE, FL, 32301 |
| ZIP code: | 32301 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447438486 | 2008-02-01 | 2011-10-05 | 1381A CROSS CREEK CIR, TALLAHASSEE, FL, 323013729, US | 1381 CROSS CREEK CIR, SUITE A, TALLAHASSEE, FL, 323013723, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-877-6393 |
| Fax | 8508776813 |
| Fax | 8508776393 |
Authorized person
| Name | DR. WAYNE A SAMPSON |
| Role | MEDICAL DIRECTOR |
| Phone | 8508776393 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 0071014FLME |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 250984900 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DF9814 |
| State | FL |
| Issuer | MEDICAID |
| Number | 003457000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAMPSON WAYNE A | President | 1381 A CROSS CREEK CIRCLE, TALLAHASSEE, FL, 32301 |
| SAMPSON WAYNE ADr. | Agent | 1605 GROVELAND HILLS DR., TALLAHASSEE, FL, 32317 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-04-24 | SAMPSON, WAYNE ANTHONY, Dr. | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-04-24 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-08 |
| ANNUAL REPORT | 2016-03-01 |
| ANNUAL REPORT | 2015-01-12 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8813187300 | 2020-05-01 | 0491 | PPP | 1381 CROSS CREEK CIR, TALLAHASSEE, FL, 32301-3729 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
