| Entity Name: | DR. GEORGE EMANOILIDIS EPIC SERVICES PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Feb 2015 (10 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P15000018943 |
| FEI/EIN Number | 46-4995587 |
| Address: | 100 FIGI CT NE, LAKE PLACID, FL, 33852, US |
| Mail Address: | 100 FIGI CT NE, LAKE PLACID, AL, 33852, US |
| ZIP code: | 33852 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245785815 | 2016-08-24 | 2016-08-24 | 21 RYANT BLVD, SUITE 21, SEBRING, FL, 338708075, US | 21 RYANT BLVD, SUITE 21, SEBRING, FL, 338708075, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 863-243-3198 |
Authorized person
| Name | DR. GEORGE EMANOILIDIS |
| Role | OWNER/LICENSED PSYCHOLOGIST |
| Phone | 8632433198 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY8561 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 103TF0200X - Forensic Psychologist |
| License Number | PY8561 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | GN537A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EMANOILIDIS GEORGE | Agent | 100 FIGI CT NE, LAKE PLACID, FL, 33852 |
| Name | Role | Address |
|---|---|---|
| EMANOILIDIS GEORGE | President | 100 FIGI CT NE, LAKE PLACID, FL, 33852 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-29 | 100 FIGI CT NE, LAKE PLACID, FL 33852 | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-29 | 100 FIGI CT NE, LAKE PLACID, FL 33852 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-03-28 |
| ANNUAL REPORT | 2016-04-29 |
| Domestic Profit | 2015-02-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
