| Entity Name: | AFC PHYSICIANS OF FLORIDA, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 19 Mar 2013 (12 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 18 Oct 2023 (a year ago) |
| Document Number: | P13000025916 |
| FEI/EIN Number | 46-2403175 |
| Address: | 3700 Cahaba Beach Road, Birmingham, AL 35242 |
| Mail Address: | 3700 Cahaba Beach Road, Birmingham, AL 35242 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609549104 | 2021-07-29 | 2021-07-29 | 3700 CAHABA BEACH RD, BIRMINGHAM, AL, 352425225, US | 1394 JOHN SIMS PKWY E STE 101, NICEVILLE, FL, 325782208, US | |||||||||||||||||||||||||
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| Phone | +1 205-403-8902 |
| Fax | 2052715571 |
| Phone | +1 850-517-1920 |
| Fax | 8505171950 |
Authorized person
| Name | PATRICK DEVERELL BIANCHI |
| Role | OWNER |
| Phone | 9047516200 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108529500 |
| State | FL |
| Name | Role |
|---|---|
| HT AGENTS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| George, Astin | Doctor | 3700 Cahaba Beach Road, Birmingham, AL 35242 |
| Name | Role | Address |
|---|---|---|
| JOHANSEN, RANDY | President | 3700 CAHABA BEACH RD, BIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| JOHANSEN, RANDY | Chief Executive Officer | 3700 CAHABA BEACH RD, BIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| HAWLEY, JOSEPH | Chief Financial Officer | 3700 CAHABA BEACH RD, BIRMINGHAM, AL 35242 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2023-10-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-05-17 | HT AGENTS, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-05-17 | 146 2ND N, STE 101, ST PETERBURG, FL 32801-3370 | No data |
| REINSTATEMENT | 2017-12-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-06-05 | 3700 Cahaba Beach Road, Birmingham, AL 35242 | No data |
| CHANGE OF MAILING ADDRESS | 2015-06-05 | 3700 Cahaba Beach Road, Birmingham, AL 35242 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-09-26 |
| Amendment | 2023-10-18 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-03-02 |
| Reg. Agent Change | 2019-05-17 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-01-11 |
| REINSTATEMENT | 2017-12-12 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
