| Entity Name: | BAPTIST OBSTETRICS AND GYNECOLOGY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jun 1997 (28 years ago) |
| Document Number: | P97000048629 |
| FEI/EIN Number | 593450324 |
| Mail Address: | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207, US |
| Address: | 3563 PHILIPS HIGHWAY, BUILDING A, SUITE 101, JACKSONVILLE, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588375794 | 2022-12-08 | 2022-12-08 | PO BOX 748867, ATLANTA, GA, 303748867, US | 463820 STATE ROAD 200 STE 103, YULEE, FL, 320973604, US | |||||||||||||||||||
|
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| Phone | +1 904-202-1032 |
| Fax | 9043764107 |
| Phone | +1 904-321-3670 |
| Fax | 9043763416 |
Authorized person
| Name | MARSHA DONALDSON |
| Role | VICE PRESIDENT |
| Phone | 9043763703 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Baity G. S | Agent | 841 PRUDENTIAL DR., JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Mayo Michael A | Director | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| Tickell Keith | Director | 841 PRUDENTIAL DRIVE, SUITE 1602, JACKSONVILLE, FL, 32207 |
| ZUINO MATTHEW A | Director | 841 Prudential Ave., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Mayo Michael A | President | 841 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| Tickell Keith | Vice President | 841 PRUDENTIAL DRIVE, SUITE 1602, JACKSONVILLE, FL, 32207 |
| GORAK EDWARD | Vice President | 841 Prudential Dr., Jacksonville, FL, 32207 |
| ZUINO MATTHEW A | Vice President | 841 Prudential Ave., Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| BAITY G. S | Secretary | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| FINNEGAN T A | Treasurer | 841 Prudential Dr., Jacksonville, FL, 32207 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041700 | BAPTIST MEDICAL GROUP | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 3563 PHILIPS HIGHWAY, BLDG A, STE 101, JACKSONVILLE, FL, 32207 |
| G24000034141 | BAPTIST OB/GYN | ACTIVE | 2024-03-06 | 2029-12-31 | No data | 3563 PHILIPS HIGHWAY, BLDG A, STE 101, JACKSONVILLE, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2008-03-12 | BAPTIST OBSTETRICS AND GYNECOLOGY, INC. | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
