| Entity Name: | PENSACOLA PODIATRY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 18 Jan 1994 (31 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Oct 2019 (5 years ago) |
| Document Number: | P94000006586 |
| FEI/EIN Number | 59-3218604 |
| Address: | 6160 N. DAVIS HIGHWAY, STE. 1, PENSACOLA, FL 32504 |
| Mail Address: | 6160 N. DAVIS HIGHWAY, STE. 1, PENSACOLA, FL 32504 |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790960508 | 2007-12-31 | 2012-10-11 | 6160 N DAVIS HWY, STE 1, PENSACOLA, FL, 325046967, US | 6160 N DAVIS HWY, STE 1, PENSACOLA, FL, 325046967, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 850-476-2805 |
| Fax | 8504763010 |
Authorized person
| Name | DIANE H STEPHENS |
| Role | OFFICE MANAGER |
| Phone | 8504762805 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 040994400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CASTAGNA, FRANK JDPM | Agent | 6160 N. DAVIS HIGHWAY, STE. 1, PENSACOLA, FL 32504 |
| Name | Role | Address |
|---|---|---|
| CASTAGNA, FRANK JDPM | Director | 4621 CANOPY ROAD, PENSACOLA, FL 32504 |
| Name | Role | Address |
|---|---|---|
| CASTAGNA, FRANK JDPM | President | 4621 CANOPY ROAD, PENSACOLA, FL 32504 |
| Name | Role | Address |
|---|---|---|
| ETHERIDGE, MATTHEW H | Vice President | 8735 FOXTAIL LOOP, PENSACOLA, FL 32526 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-10-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-14 | CASTAGNA, FRANK JDPM | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| NAME CHANGE AMENDMENT | 2007-05-03 | PENSACOLA PODIATRY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-02-11 |
| ANNUAL REPORT | 2021-02-15 |
| ANNUAL REPORT | 2020-01-22 |
| REINSTATEMENT | 2019-10-14 |
| ANNUAL REPORT | 2018-03-19 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
