| Entity Name: | WEST BOCA PHYSICIANS GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 10 Sep 2007 (17 years ago) |
| Date of dissolution: | 26 Jun 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 26 Jun 2018 (7 years ago) |
| Document Number: | P07000100692 |
| FEI/EIN Number | 26-1080110 |
| Address: | 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 |
| Mail Address: | 265 BROOKVIEW CENTRE WAY, SUITE 400, ATTN: Legal Dept., KNOXVILLE, TN 37919 |
| ZIP code: | 33321 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255529186 | 2007-10-04 | 2007-12-26 | 14050 NW 14TH ST, SUITE 190, SUNRISE, FL, 333232865, US | 21644 STATE ROAD 7, BOCA RATON, FL, 334281842, US | |||||||||||||||||||||||||
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| Phone | +1 800-424-3672 |
| Phone | +1 561-883-7029 |
Authorized person
| Name | DR. STEPHEN G. HOLTZCLAW |
| Role | PRESIDENT |
| Phone | 8004243672 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS OF FLORIDA |
| Number | 98221 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| UPPAL, ROHIT, MD | Director | 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 |
| Name | Role | Address |
|---|---|---|
| UPPAL, ROHIT, MD | President | 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 |
| Name | Role | Address |
|---|---|---|
| STAIR, JOHN | Assistant Secretary | 265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN 37919 |
| Name | Role | Address |
|---|---|---|
| barrack, john | Assistant Treasurer | 265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN 37919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-06-26 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-19 | 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-12 | 5870 North Hiatus Road, Suite 200, Tamarac, FL 33321 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-04-12 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-14 |
| ANNUAL REPORT | 2014-04-03 |
| ANNUAL REPORT | 2013-04-18 |
| ANNUAL REPORT | 2012-04-11 |
| ANNUAL REPORT | 2011-04-18 |
| ANNUAL REPORT | 2010-04-23 |
| ANNUAL REPORT | 2009-04-14 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
