| Entity Name: | NORTHWEST FLORIDA ANESTHESIA CONSULTANTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Oct 1993 (31 years ago) |
| Document Number: | P93000076144 |
| FEI/EIN Number | 593207727 |
| Address: | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323, US |
| Mail Address: | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323, US |
| ZIP code: | 33323 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497702229 | 2006-05-27 | 2020-08-22 | PO BOX 840237, PEMBROKE PINES, FL, 330842237, US | 1613 HARRISON PKWY, #200, SUNRISE, FL, 333232853, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-838-2371 |
Authorized person
| Name | LEWIS GOLD |
| Role | PRESIDENT |
| Phone | 9548382371 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 24278A |
| State | FL |
| Issuer | RAILROAD |
| Number | CI0927 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTUS JAY A | Agent | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| DROZDOW GILBERT | Secretary | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| MARTUS JAY | Secretary | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| carlyle john | Chief Executive Officer | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| carlyle john | Director | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| COWARD ROBERT | Director | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| COWARD ROBERT | President | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| MARTUS JAY | Executive Vice President | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| TIMMONS RUBEN M | Vice President | 510 CORDAY STREET, PENSACOLA, FL, 32503 |
| DROZDOW GILBERT | Vice President | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08283900028 | NORTH FLORIDA ANESTHESIA CONSULTANTS | EXPIRED | 2008-10-09 | 2013-12-31 | No data | 1613 NORTH HARRISON PARKWAY, SUITE 200, SUNRISE, FL, 33323 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2013-12-12 | No data | No data |
| CANCEL ADM DISS/REV | 2003-11-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| NAME CHANGE AMENDMENT | 1998-01-28 | NORTHWEST FLORIDA ANESTHESIA CONSULTANTS, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
