| Entity Name: | BAPTIST AGEWELL PHYSICIANS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Mar 2012 (13 years ago) |
| Document Number: | P12000022837 |
| FEI/EIN Number | 38-3870378 |
| Address: | 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL, 32207, US |
| Mail Address: | 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124788146 | 2021-12-20 | 2021-12-20 | PO BOX 3162, SALT LAKE CITY, UT, 841103162, US | 700 3RD ST STE 102, NEPTUNE BEACH, FL, 322665082, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-202-1032 |
| Fax | 9043764107 |
| Phone | +1 904-202-4243 |
| Fax | 9042024639 |
Authorized person
| Name | GAYLE BLACKMER |
| Role | EXECUTIVE DIRECTOR |
| Phone | 9042024104 |
Taxonomy
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Baity G. Scott | Agent | 841 PRUDENTIAL DR, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Mayo Michael A | President | 841 Prudential Drive, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Secretary | 841 Prudential Drive, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| ZUINO MATTHEW A | Vice President | 841 Prudential Dr, Jacksonville, FL, 32207 |
| Tickell Keith | Vice President | 841 Prudential Drive, Jacksonville, FL, 32207 |
| GORAK EDWARD DO | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| FINNEGAN T A | Treasurer | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041693 | BAPTIST MEDICAL GROUP | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| G24000034142 | BAPTIST AGEWELL | ACTIVE | 2024-03-06 | 2029-12-31 | No data | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-30 | 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL 32207 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-04-30 | Baity, G. Scott | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-28 | 841 Prudential Drive, Suite 1802, JACKSONVILLE, FL 32207 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-16 |
| 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: 02 Feb 2025
Sources: Florida Department of State
