| Entity Name: | PALM BEACH OSTEOPATHIC CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Apr 2004 (21 years ago) |
| Document Number: | P04000060233 |
| FEI/EIN Number | 020725008 |
| Address: | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL, 33410, US |
| Mail Address: | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL, 33410, US |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497964407 | 2007-05-22 | 2020-11-16 | 10887 N MILITARY TRL STE 5, PALM BEACH GARDENS, FL, 334106528, US | 10887 N MILITARY TRL STE 5, PALM BEACH GARDENS, FL, 334106528, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-324-9600 |
| Fax | 5617999980 |
Authorized person
| Name | MRS. DEBORAH DODGE |
| Role | AM |
| Phone | 5613249600 |
Taxonomy
| Taxonomy Code | 204D00000X - Neuromusculoskeletal Medicine & OMM Physician |
| License Number | OS9152 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | OS9152 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | FLORIDA MEDICAL LICENSE |
| Number | OS9152 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Wisnioski Stanley WIII | Agent | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL, 33410 |
| Name | Role | Address |
|---|---|---|
| WISNIOSKI STANLEY W | President | 13300 RUNNING WATER ROAD, WEST PALM BEACH, FL, 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-17 | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-17 | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL 33410 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-03-17 | Wisnioski, Stanley W, III | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-17 | 10887 N. MILITARY TRAIL, SUITE 5, PALM BEACH GARDENS, FL 33410 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-02-23 |
| ANNUAL REPORT | 2015-03-25 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6304027301 | 2020-04-30 | 0455 | PPP | 10800 North Military Trail, Palm Beach Gardens, FL, 33410 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Feb 2025
Sources: Florida Department of State
