| Entity Name: | INPATIENT HOSPITAL NEUROLOGISTS PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 13 Jul 2004 (21 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P04000103835 |
| FEI/EIN Number | 432054998 |
| Address: | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL, 34786 |
| Mail Address: | 13506 SUMMERPORT VILLAGE PARKWAY, #413, WINDERMERE, FL, 34786 |
| ZIP code: | 34786 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811067150 | 2006-11-08 | 2008-05-20 | PO BOX 741240, ORANGE CITY, FL, 327741240, US | 13506 SUMMERPORT VILLAGE PKWY, #413, WINDERMERE, FL, 347867366, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-774-5211 |
| Fax | 3867745251 |
| Phone | +1 407-905-4997 |
| Fax | 4078769808 |
Authorized person
| Name | EVAN ALLEN |
| Role | PRESIDENT OWNER |
| Phone | 4079054997 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME82452 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 262555500 |
| State | FL |
| Issuer | BCBSFL |
| Number | 58985 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DC4472 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALLEN EVAN | Agent | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| ALLEN EVAN D | Director | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| ALLEN DENISE M | Manager | 8436 LAKE BURDEN CIRCLE, WINDERMERE, FL, 34786 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2017-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-28 | ALLEN, EVAN | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CANCEL ADM DISS/REV | 2009-08-06 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2009-08-06 | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL 34786 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-10-09 | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL 34786 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-10-09 | 8436 LAKE BURDEN CIRCLE, WINDEMERE, FL 34786 | No data |
| CANCEL ADM DISS/REV | 2006-10-09 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-14 |
| REINSTATEMENT | 2017-09-28 |
| ANNUAL REPORT | 2015-03-04 |
| ANNUAL REPORT | 2014-03-04 |
| ANNUAL REPORT | 2013-01-29 |
| ANNUAL REPORT | 2012-04-14 |
| ANNUAL REPORT | 2011-06-15 |
| ANNUAL REPORT | 2010-02-14 |
| REINSTATEMENT | 2009-08-06 |
| ANNUAL REPORT | 2007-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
