| Entity Name: | BRUNNER SURGICAL INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 10 Jun 2014 (11 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P14000050064 |
| FEI/EIN Number | 46-4922115 |
| Address: | 4218 5TH AVE, MARIANNA, FL, 32447 |
| Mail Address: | 4218 5TH AVE, MARIANNA, FL, 32447 |
| ZIP code: | 32447 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164830725 | 2014-07-28 | 2014-08-12 | 2919 GREEN ST, MARIANNA, FL, 324463345, US | 4318 5TH AVE, MARIANNA, FL, 324462182, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-209-4576 |
| Fax | 8505261323 |
Authorized person
| Name | DR. RICHARD G BRUNNER |
| Role | PRESIDENT |
| Phone | 8502094576 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | ME0046858 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 02676 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRUNNER RICHARD | Agent | 2919 GREEN ST, MARIANNA, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| BRUNNER RICK | President | 2919 GREEN ST, MARIANNA, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| BRUNNER RICK | Director | 2919 GREEN ST, MARIANNA, FL, 32446 |
| BRUNNER SARA | Director | 2919 GREEN ST, MARIANNA, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| BRUNNER SARA | Vice President | 2919 GREEN ST, MARIANNA, FL, 32446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-05-01 | 4218 5TH AVE, MARIANNA, FL 32447 | No data |
| CHANGE OF MAILING ADDRESS | 2025-05-01 | 4218 5TH AVE, MARIANNA, FL 32447 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-01 | 4218 5TH AVE, MARIANNA, FL 32447 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-01 | 4218 5TH AVE, MARIANNA, FL 32447 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-23 |
| Domestic Profit | 2014-06-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
