| Entity Name: | RURAL PRIMARY CARE SOUTH-WALTON, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Dec 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 07 Nov 2020 (4 years ago) |
| Document Number: | P19000091652 |
| FEI/EIN Number | 84-3984960 |
| Address: | 5551 HWY 98 STE 2, SANTA ROSA BEACH, FL, 32459 |
| Mail Address: | 5551 HWY 98 STE 2, SANTA ROSA BEACH, FL, 32459 |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912545955 | 2019-12-19 | 2022-02-04 | 5551 US HIGHWAY 98, SUITE 2, SANTA ROSA BEACH, FL, 32459, US | 5551 US HIGHWAY 98, SUITE 2, SANTA ROSA BEACH, FL, 32459, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 850-420-5420 |
| Fax | 8502448011 |
Authorized person
| Name | AMANDA PATTON |
| Role | PRACTICE MANAGER |
| Phone | 8504205420 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110818301 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LINNED WILLIAM V | Agent | 5551 HWY 98 STE 2, SANTA ROSA BEACH, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| PATTON MICHAEL | Director | 328 HIGHLAND VIEW DR, BIRMINGHAM, AL, 35242 |
| PATTON AMANDA | Director | 328 HIGHLAND VIEW DR, BIRMINGHAM, AL, 35242 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-11-07 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-11-07 | LINNED, WILLIAM V | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-01-30 |
| AMENDED ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-04 |
| REINSTATEMENT | 2020-11-07 |
| Domestic Profit | 2019-12-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
