| Entity Name: | BAPTIST UROLOGY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Apr 2013 (12 years ago) |
| Document Number: | P13000034970 |
| FEI/EIN Number | 46-2632312 |
| Address: | 3563 PHILIPS HWY, BUILDING A, SUITE 101, JACKSONVILLE, FL, 32207, US |
| Mail Address: | 3563 PHILIPS HWY, 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689011710 | 2013-05-30 | 2018-12-12 | PO BOX 2421, SALT LAKE CITY, UT, 841102421, US | 1348 S 18TH ST STE 210, FERNANDINA BEACH, FL, 320344785, US | |||||||||||||||||||||||||||
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| Phone | +1 904-202-1032 |
| Fax | 9043764107 |
| Phone | +1 904-261-9108 |
| Fax | 9042619911 |
Authorized person
| Name | MASHA DONALDSON |
| Role | ADMINISTRATOR |
| Phone | 9043763707 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DU3519 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Baity G. S | 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 |
|---|---|---|
| Groover, MD Timothy | Director | 841 Prudential Drive, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| GORAK EDWARD | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| TICKELL KEITH A | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| FINNEGAN T S | Treasurer | 841 Prudential Dr, Jacksonville, FL, 32207 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041690 | BAPTIST MEDICAL GROUP | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 3563 PHILIPS HIGHWAY, BLDG A, STE 101, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-30 | Baity, G. Scott | 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 Feb 2025
Sources: Florida Department of State
