| Entity Name: | BAPTIST PULMONARY SPECIALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Feb 2009 (16 years ago) |
| Document Number: | P09000014133 |
| FEI/EIN Number | 800351279 |
| Mail Address: | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207, US |
| Address: | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689817405 | 2009-04-09 | 2021-03-03 | PO BOX 2462, SALT LAKE CITY, UT, 841102462, US | 1660 PRUDENTIAL DR STE 320, JACKSONVILLE, FL, 322078197, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-202-1032 |
| Fax | 9043764107 |
| Phone | +1 904-376-3707 |
| Fax | 9043915001 |
Authorized person
| Name | CATHERINE HOLLOWAY |
| Role | DIRECTOR |
| Phone | 9042025378 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RS0010X - Sports Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE GROUP PTAN |
| Number | BY513A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Agent | 841 PRUDENTIAL DR., SUITE 1802, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Groover, MD Timothy | Director | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| ZUINO MATTHEW A | Director | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Secretary | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Tickell Keith | Vice President | 841 Prudential Drive, Jacksonville, FL, 32207 |
| GORAK EDWARD DO | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| MAYO MICHAEL A | President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041698 | BAPTIST MEDICAL GROUP | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 3563 PHILIPS HIGHWAY, BLDG A, STE 101, JACKSONVILLE, FL, 32207 |
| G24000034140 | BAPTIST PULMONARY | ACTIVE | 2024-03-06 | 2029-12-31 | No data | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-30 | Baity, G. Scott | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-30 | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL 32207 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-30 | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL 32207 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-11-06 | 841 PRUDENTIAL DR., SUITE 1802, JACKSONVILLE, FL 32207 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
