| Entity Name: | PA SURGICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Mar 2003 (22 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P03000033804 |
| FEI/EIN Number | 510454607 |
| Mail Address: | 5500 MILITARY TRAIL, JUPITER, FL, 33458, US |
| Address: | 5500 Military Trail, Jupiter, FL, 33458, US |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942313879 | 2006-08-16 | 2020-09-22 | 621 NW 53RD ST STE 330, BOCA RATON, FL, 334878281, US | 621 NW 53RD ST STE 330, BOCA RATON, FL, 334878281, US | |||||||||||||||||||||||||||
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| Phone | +1 800-488-0279 |
| Fax | 8669028817 |
| Phone | +1 561-440-7612 |
Authorized person
| Name | NANCY T BOURG |
| Role | CEO |
| Phone | 5618891227 |
Taxonomy
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | X1578 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Carpenter Joseph EJr. | Agent | 111 SE 12 Street, Fort Lauderdale, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| Bourg Nancy | President | 5500 Military Trail, Jupiter, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-18 | 5500 Military Trail, Suite 22-324, Jupiter, FL 33458 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-05 | 5500 Military Trail, Suite 22-324, Jupiter, FL 33458 | No data |
| AMENDMENT | 2018-05-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-01-09 | Carpenter, Joseph E, Jr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-09 | 111 SE 12 Street, Fort Lauderdale, FL 33316 | No data |
| AMENDMENT | 2013-05-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-05-14 |
| ANNUAL REPORT | 2019-04-15 |
| Amendment | 2018-05-14 |
| ANNUAL REPORT | 2018-01-09 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
