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PHYSICIAN PROVIDERS GROUP, P.A. - Florida Company Profile

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Company Details

Entity Name: PHYSICIAN PROVIDERS GROUP, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 27 May 2003 (22 years ago)
Document Number: P03000060632
FEI/EIN Number 510473464
Address: 305 S LINE AVENUE, INVERNESS, FL, 34452, US
Mail Address: 305 S Line Ave, Inverness, FL, 34452, US
ZIP code: 34452
City: Inverness
County: Citrus
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
ULSETH ROBERT Dr. President 305 S LINE AVENUE, INVERNESS, FL, 34452
ULSETH ROBERT M Agent 305 S LINE AVENUE, INVERNESS, FL, 34452

Commercial and government entity program

CAGE number:
8S2H8
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2023-06-25
CAGE Expiration:
2025-12-01

Contact Information

POC:
TERESA MCPHERSON

National Provider Identifier

NPI Number:
1396200283
Certification Date:
2023-07-03

Authorized Person:

Name:
ROBERT ULSETH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
8887703208
Fax:
3523443822

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000113931 COMPREHENSIVE PAIN MANAGEMENT CENTER ACTIVE 2012-11-28 2027-12-31 - 8 OCALE WAY N, SUMMERFIELD, FL, 34491

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-04-30 305 S LINE AVENUE, INVERNESS, FL 34452 -
CHANGE OF PRINCIPAL ADDRESS 2013-08-15 305 S LINE AVENUE, INVERNESS, FL 34452 -
REGISTERED AGENT ADDRESS CHANGED 2013-08-15 305 S LINE AVENUE, INVERNESS, FL 34452 -

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-01-26
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-02-08
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-01
ANNUAL REPORT 2016-02-25
ANNUAL REPORT 2015-01-16

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Date of last update: 01 Aug 2025

Sources: Florida Department of State