| Entity Name: | ATLANTIC NEPHROLOGY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 09 Jun 2008 (17 years ago) |
| Document Number: | P08000056408 |
| FEI/EIN Number | 26-2782319 |
| Address: | 210 Old Kings Road South, Suite #900, Flagler Beach, FL 32136 |
| Mail Address: | 210 Old Kings Road South, Suite #900, Flagler Beach, FL 32136 |
| ZIP code: | 32136 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376704155 | 2008-06-24 | 2013-03-04 | 61 MEMORIAL MEDICAL PKWY, SUITE #3806, PALM COAST, FL, 321645981, US | 61 MEMORIAL MEDICAL PKWY, SUITE #3806, PALM COAST, FL, 321645981, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 386-437-7340 |
Authorized person
| Name | DR. WILLIAM BONLORE FERGUSON |
| Role | PRESIDENT/OWNER |
| Phone | 3868713767 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | ME94793 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 250792700 |
| State | FL |
| Issuer | MEDICARE NUMBER |
| Number | 40336 |
| State | FL |
| Issuer | PTAN |
| Number | AD824Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERGUSON, LINDA | Agent | 5967 BOGGS FORD ROAD, PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| FERGUSON, WILLIAM B | President | 5967 BOGGS FORD ROAD, PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| FERGUSON, LINDA | Treasurer | 5967 BOGGS FORD ROAD, PORT ORANGE, FL 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-06 | 210 Old Kings Road South, Suite #900, Flagler Beach, FL 32136 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-06 | 210 Old Kings Road South, Suite #900, Flagler Beach, FL 32136 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-19 | 5967 BOGGS FORD ROAD, PORT ORANGE, FL 32127 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-19 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
