| Entity Name: | STACY EDWARDS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Apr 2006 (19 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Sep 2024 (5 months ago) |
| Document Number: | P06000051479 |
| FEI/EIN Number | 861166353 |
| Address: | 2623 McCormick Drive, Clearwater, FL, 33759, US |
| Mail Address: | 2623 McCormick Drive, Clearwater, FL, 33759, US |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730105172 | 2006-07-15 | 2024-10-29 | 1022 MAIN ST, SUITE M, DUNEDIN, FL, 346985225, US | 2623 MCCORMICK DR STE 101, CLEARWATER, FL, 337591046, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-733-7922 |
| Fax | 7377386205 |
| Phone | +1 727-564-9336 |
| Fax | 7272233228 |
Authorized person
| Name | DR. STACY L EDWARDS |
| Role | PHYSICIAN |
| Phone | 7274106655 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS7714 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 257297 |
| State | FL |
| Issuer | AETNA |
| Number | 5580758 |
| State | FL |
| Issuer | HUMANA |
| Number | 123421 |
| State | FL |
| Issuer | BCBS |
| Number | 20886 |
| State | FL |
| Issuer | CIGNA |
| Number | 0161979008 |
| State | FL |
| Issuer | AETNA |
| Number | 1057441 |
| State | FL |
| Issuer | BAYCARE |
| Number | 1320 |
| State | FL |
| Issuer | UHC |
| Number | 0001713 |
| State | FL |
| Issuer | UHC |
| Number | 0412595 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EDWARDS STACY | Agent | 2283 RANCHETTE LANE, DUNEDIN, FL, 34698 |
| Name | Role | Address |
|---|---|---|
| EDWARDS STACY L | President | 2283 RANCHETTE LANE, DUNEDIN, FL, 34698 |
| Name | Role | Address |
|---|---|---|
| BUETTNER LARRY | Secretary | 2283 RANCHETTE LANE, DUNEDIN, FL, 34698 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-03 | 2623 McCormick Drive, Suite 101, Clearwater, FL 33759 | No data |
| REINSTATEMENT | 2024-09-12 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-12 | 2623 McCormick Drive, Suite 101, Clearwater, FL 33759 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-09-12 | EDWARDS, STACY | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-06 | 2283 RANCHETTE LANE, DUNEDIN, FL 34698 | No data |
| AMENDMENT | 2009-11-12 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-10-03 |
| REINSTATEMENT | 2024-09-12 |
| ANNUAL REPORT | 2016-03-06 |
| ANNUAL REPORT | 2015-03-05 |
| ANNUAL REPORT | 2014-03-25 |
| ANNUAL REPORT | 2013-03-20 |
| ANNUAL REPORT | 2012-03-02 |
| ANNUAL REPORT | 2011-04-12 |
| ANNUAL REPORT | 2010-04-01 |
| Amendment | 2009-11-12 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
