| Entity Name: | HOSPITALIST GROUP OF NORTHWEST FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Apr 2021 (4 years ago) |
| Document Number: | P21000032516 |
| FEI/EIN Number | 86-3247242 |
| Address: | 4000 Highway 90, Pace, FL, 32571, US |
| Mail Address: | 4000 Highway 90, Pace, FL, 32571, US |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386385045 | 2022-04-06 | 2023-12-01 | PO BOX 30694, PENSACOLA, FL, 325031694, US | 1101 OFFICE WOODS DR, PENSACOLA, FL, 325045937, US | |||||||||||||||||||||
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| Phone | +1 850-478-1312 |
| Fax | 8504749060 |
Authorized person
| Name | ROMAN BAUTISTA |
| Role | PRESIDENT |
| Phone | 8507764265 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114264100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAUTISTA ROMAN SD.O. | Agent | 4000 Highway 90, Pace, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| SAMII STEVEN SM.D. | Director | 31 E. GALVEZ COURT, PENSACOLA BEACH, FL, 32561 |
| BAUTISTA ROMAN SD.O. | Director | 3978 GORDON WELLS DRIVE, MILTON, FL, 32583 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-29 | 4000 Highway 90, Suite I, Pace, FL 32571 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-29 | 4000 Highway 90, Suite I, Pace, FL 32571 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-29 | 4000 Highway 90, Suite I, Pace, FL 32571 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-29 |
| Domestic Profit | 2021-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
