| Entity Name: | AFFILIATED FOOT & ANKLE PROVIDERS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Sep 1993 (31 years ago) |
| Document Number: | P93000067143 |
| FEI/EIN Number | 593203352 |
| Address: | 232 BULLARD PARKWAY, TEMPLE TERRACE, FL, 33617 |
| Mail Address: | 232 BULLARD PARKWAY, TEMPLE TERRACE, FL, 33617 |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568015865 | 2019-07-17 | 2019-07-17 | 232 BULLARD PKWY, TEMPLE TERRACE, FL, 336175512, US | 232 BULLARD PKWY, TEMPLE TERRACE, FL, 336175512, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 813-985-1665 |
| Fax | 8139853045 |
Authorized person
| Name | STANLEY S SHAMA |
| Role | PRESIDENT |
| Phone | 8139851665 |
Taxonomy
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | IPA AGREEMENT |
| Number | 45842 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAMA STANLEY S | Agent | 232 BULLARD PARKWAY, TEMPLE TERRACE, FL, 33617 |
| Name | Role | Address |
|---|---|---|
| SHAMA STANLEY S | DPM | 232 BULLARD PKWY, TEMPLE TERRACE, FL, 33617 |
| Name | Role | Address |
|---|---|---|
| VALINS ROBERT J | Director | 6336 FT KING RD, ZEPHYRHILLS, FL |
| BLASS BARRY | Director | 1020 W HILLSBOROUGH AVE, TAMPA, FL, 33603 |
| BAKER STEVEN | Director | 2511 W BUFFALO AVE, TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1994-04-12 | AFFILIATED FOOT & ANKLE PROVIDERS, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
