| Entity Name: | BAYSIDE URGENT CARE CENTER INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Oct 2010 (14 years ago) |
| Document Number: | P10000083062 |
| FEI/EIN Number | 273670095 |
| Address: | 1001 S. FORT HARRISON AVE, SUITE 101, CLEARWATER, FL, 33756, US |
| Mail Address: | 1001 S. FORT HARRISON AVE, SUITE 101, CLEARWATER, FL, 33756, US |
| ZIP code: | 33756 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619257755 | 2011-08-21 | 2011-08-21 | 10030 NEW PARKE RD, TAMPA, FL, 336265414, US | 1001 S FORT HARRISON AVE, SUITE 101, CLEARWATER, FL, 337563905, US | |||||||||||||||||||||||||
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| Phone | +1 813-508-2225 |
| Fax | 8139204999 |
Authorized person
| Name | DR. RICHARD PETERKIN WALLACE |
| Role | PRESIDENT/CEO |
| Phone | 8135082225 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | BTR-0029514 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 270183900 |
| State | FL |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| WALLACE RICHARD P | President | 1001 S. FT. HARRISON AVE. STE 101, CLEARWATER, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| WALLACE RICHARD P | Director | 1001 S. FT. HARRISON AVE. STE 101, CLEARWATER, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| WALLACE RICHARD P | Treasurer | 1001 S. FT. HARRISON AVE. STE 101, CLEARWATER, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| WALLACE RICHARD P | Secretary | 1001 S. FT. HARRISON AVE. STE 101, CLEARWATER, FL, 33756 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-18 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-08-17 | 1001 S. FORT HARRISON AVE, SUITE 101, CLEARWATER, FL 33756 | No data |
| CHANGE OF MAILING ADDRESS | 2011-08-17 | 1001 S. FORT HARRISON AVE, SUITE 101, CLEARWATER, FL 33756 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001172965 | TERMINATED | 13-1592 CI 7 | PINELLAS COUNTY CIRCUIT COURT | 2013-07-08 | 2018-07-10 | $23,553.94 | PHYSICIAN SALES & SERVICE, INC., C/O WILLIAM M. LINDEMAN, P.A., P.O. BOX 3506, ORLANDO, FL 32802 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-02-22 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-09 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
