| Entity Name: | JACK PFEILSTICKER M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Apr 2004 (21 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Jan 2011 (14 years ago) |
| Document Number: | P04000059263 |
| FEI/EIN Number | 562452593 |
| Address: | 6302 MANATEE AVENUE WEST, SUITE I-2, BRADENTON, FL, 34209 |
| Mail Address: | 6302 MANATEE AVENUE WEST, SUITE I-2, BRADENTON, FL, 34209 |
| ZIP code: | 34209 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265573018 | 2007-02-12 | 2011-04-08 | 4701 MANATEE AVE W, BRADENTON, FL, 342093851, US | 4701 MANATEE AVE W, BRADENTON, FL, 342093851, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 941-747-2282 |
| Fax | 9417570656 |
Authorized person
| Name | DR. JOHN ANDREW PFEILSTICKER |
| Role | OWNER |
| Phone | 9417472282 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME46226 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266225600 |
| State | FL |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| PFEILSTICKER JACK | President | 6302 MANATEE AVENUE WEST, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| PFEILSTICKER JACK | Secretary | 6302 MANATEE AVENUE WEST, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| PFEILSTICKER JACK | Treasurer | 6302 MANATEE AVENUE WEST, BRADENTON, FL, 34209 |
| Name | Role | Address |
|---|---|---|
| PFEILSTICKER JACK | Director | 6302 MANATEE AVENUE WEST, BRADENTON, FL, 34209 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2012-04-10 | 6302 MANATEE AVENUE WEST, SUITE I-2, BRADENTON, FL 34209 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-10 | 6302 MANATEE AVENUE WEST, SUITE I-2, BRADENTON, FL 34209 | No data |
| REINSTATEMENT | 2011-01-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CANCEL ADM DISS/REV | 2009-11-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2007-03-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-25 |
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-01-16 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-02-10 |
| ANNUAL REPORT | 2017-05-02 |
| ANNUAL REPORT | 2016-01-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
