| Entity Name: | PANHANDLE RURAL HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Feb 1994 (31 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Aug 2017 (7 years ago) |
| Document Number: | P94000008412 |
| FEI/EIN Number | 59-3216460 |
| Address: | 14088 ALABAMA ST, JAY, FL 32565 |
| Mail Address: | P.O.BOX 10, JAY, FL 32565 |
| ZIP code: | 32565 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255398228 | 2006-04-26 | 2012-07-05 | PO BOX 10, JAY, FL, 325650010, US | 14088 ALABAMA ST, JAY, FL, 325651036, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 850-675-4546 |
| Fax | 8506754548 |
Authorized person
| Name | DR. CLEATIOUS DAVID SMITH I |
| Role | OWNER SUPERVISING PHYSICIAN |
| Phone | 8506754546 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 660022102 |
| State | FL |
| Issuer | BCBS OF FLORIDA GROUP NUMBER |
| Number | 21333 |
| State | FL |
| Issuer | MEDICAID |
| Number | 660022100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH, C D | Agent | 14088 ALABAMA STREET, JAY, FL 32565 |
| Name | Role | Address |
|---|---|---|
| SMITH, C D | President | 5100 HIGHWAY 4, JAY, FL 32565 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-14 | 14088 ALABAMA STREET, JAY, FL 32565 | No data |
| REINSTATEMENT | 2017-08-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-08-28 | SMITH, C D | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-04 | 14088 ALABAMA ST, JAY, FL 32565 | No data |
| CHANGE OF MAILING ADDRESS | 2004-11-09 | 14088 ALABAMA ST, JAY, FL 32565 | No data |
| CANCEL ADM DISS/REV | 2004-11-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-02-06 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-30 |
| REINSTATEMENT | 2017-08-28 |
| ANNUAL REPORT | 2014-01-21 |
| ANNUAL REPORT | 2013-01-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
