| Entity Name: | SAMUEL M. EDWARDS, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 Mar 1997 (28 years ago) |
| Document Number: | P97000021770 |
| FEI/EIN Number | 59-3429448 |
| Address: | 750 W. PLYMOUTH AVE., DELAND, FL 32720 |
| Mail Address: | 750 W. PLYMOUTH AVE., DELAND, FL 32720 |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023394707 | 2011-10-26 | 2011-10-26 | 750 W PLYMOUTH AVE, DELAND, FL, 327203282, US | 750 W PLYMOUTH AVE, DELAND, FL, 327203282, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 386-736-7244 |
| Fax | 3867368538 |
Authorized person
| Name | MRS. LYNETTE A TARNOWSKI |
| Role | OFFICE MANAGER |
| Phone | 3867367244 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0066309 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 272821400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EDWARDS, SAMUEL M | Agent | 750 W. PLYMOUTH AVE., DELAND, FL 32720 |
| Name | Role | Address |
|---|---|---|
| EDWARDS, SAMUEL M | President | 750 W. PLYMOUTH AVE., DELAND, FL 32720 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2002-07-02 | 750 W. PLYMOUTH AVE., DELAND, FL 32720 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-06-12 |
| ANNUAL REPORT | 2018-04-28 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
