| Entity Name: | PHILIP COLAIZZO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Feb 1995 (30 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Jan 2013 (12 years ago) |
| Document Number: | P95000013349 |
| FEI/EIN Number | 650556932 |
| Address: | 170 S BARFIELD HWY, Suite 108, PAHOKEE, FL, 33476, US |
| Mail Address: | PO Box 4073, Tequesta, FL, 33469, US |
| ZIP code: | 33476 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356376867 | 2006-07-12 | 2022-12-06 | 6650 W INDIANTOWN RD, SUITE 110, JUPITER, FL, 334584628, US | 170 S BARFIELD HWY, SUITE 108, PAHOKEE, FL, 334761876, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-575-9876 |
| Fax | 5615752858 |
| Phone | +1 561-924-5155 |
| Fax | 5619247723 |
Authorized person
| Name | PHILIP COLAIZZO |
| Role | OWNER |
| Phone | 5615759876 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102625101 |
| State | FL |
| Issuer | MEDICAID |
| Number | 102625100 |
| State | FL |
| Issuer | BCBS |
| Number | 45348 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COLAIZZO PHILIP D | Agent | 9283 SE COVE POINT, TEQUESTA, FL, 33469 |
| Name | Role | Address |
|---|---|---|
| COLAIZZO PHILIP | Director | 9283 SE COVE POINT ST, TEQUESTA, FL, 33469 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2018-01-31 | 170 S BARFIELD HWY, Suite 108, PAHOKEE, FL 33476 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-29 | 170 S BARFIELD HWY, Suite 108, PAHOKEE, FL 33476 | No data |
| REINSTATEMENT | 2013-01-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REINSTATEMENT | 2011-10-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-05-02 | 9283 SE COVE POINT, TEQUESTA, FL 33469 | No data |
| REGISTERED AGENT NAME CHANGED | 1999-04-20 | COLAIZZO, PHILIP DR | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-31 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-19 |
| ANNUAL REPORT | 2015-06-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
