| Entity Name: | GEOFFREY ROBERTS, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Feb 1995 (30 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P95000015947 |
| FEI/EIN Number | 593282186 |
| Address: | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 34429, US |
| Mail Address: | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 34429, US |
| ZIP code: | 34429 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336134592 | 2005-09-14 | 2011-08-23 | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 344299072, US | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 344299072, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 352-795-5544 |
Authorized person
| Name | GEOFFREY ROBERTS |
| Role | PHYSICIAN |
| Phone | 3527955544 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS4752 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 660031000 |
| State | FL |
| Issuer | BCBS |
| Number | 82659 |
| State | FL |
| Issuer | MEDICARE PART B TRADITION |
| Number | K0670 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROBERTS GEOFFREY | Agent | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| ROBERTS GEOFFREY | Director | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL, 34429 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CANCEL ADM DISS/REV | 2010-05-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2000-01-28 | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34429 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1997-01-14 | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34429 | No data |
| CHANGE OF MAILING ADDRESS | 1997-01-14 | 756 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34429 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000800473 | LAPSED | 2013-CA-841 | 5TH CIRCUIT / CITRUS COUNTY | 2014-07-24 | 2019-08-06 | $458,540.32 | REGIONS BANK, 1900 FIFTH AVENUE NORTH, BIRMINGHAM, AL 35203 |
| Name | Date |
|---|---|
| REINSTATEMENT | 2010-05-10 |
| ANNUAL REPORT | 2008-04-11 |
| ANNUAL REPORT | 2007-04-22 |
| ANNUAL REPORT | 2006-04-18 |
| ANNUAL REPORT | 2005-06-30 |
| ANNUAL REPORT | 2004-02-04 |
| ANNUAL REPORT | 2003-02-03 |
| ANNUAL REPORT | 2002-04-22 |
| ANNUAL REPORT | 2001-07-18 |
| ANNUAL REPORT | 2000-01-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
