| Entity Name: | WOLVERINE ANESTHESIA CONSULTANTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Oct 1998 (26 years ago) |
| Document Number: | P98000089413 |
| FEI/EIN Number | 593537483 |
| Address: | 7111 Fairway Drive, Suite 450, Palm Beach Gardens, FL, 33418, US |
| Mail Address: | 265 BROOKVIEW CENTRE WAY - STE. 400, ATTN: LEGAL, KNOXVILLE, TN, 37919, US |
| ZIP code: | 33418 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558381392 | 2006-07-21 | 2013-12-05 | 7111 FAIRWAY DR, SUITE 450, PALM BEACH GARDENS, FL, 334184204, US | 1414 KUHL AVE, ORLANDO, FL, 328062008, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-799-3552 |
| Fax | 8652913224 |
Authorized person
| Name | JEFFREY WEISS |
| Role | PRESIDENT |
| Phone | 5617993552 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 367H00000X - Anesthesiologist Assistant |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE - RRGA |
| Number | CI6774 |
| State | FL |
| Issuer | MEDICAID |
| Number | 255628600 |
| State | FL |
| Issuer | BCBS |
| Number | 38225 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Weiss Jeffrey MD | President | 7111 Fairway Drive, Suite 450, Palm Beach Gardens, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| Rogers Oliver | Director | 7111 Fairway Drive, Suite 450, Palm Beach Gardens, FL, 33418 |
| Snow Michael | Director | 265 BROOKVIEW CENTRE WAY - STE. 400, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Wohlner Elliott MD | Vice President | 7111 Fairway Drive, Suite 450, Palm Beach Gardens, FL, 33418 |
| Allen Heidi | Vice President | 265 BROOKVIEW CENTRE WAY - STE. 400, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Beuerle Don | Chief Financial Officer | 7111 Fairway Drive, Suite 450, Palm Beach Gardens, FL, 33418 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000094542 | WOLVERINE ANESTHESIA OF TEAMHEALTH | EXPIRED | 2015-09-15 | 2020-12-31 | No data | 7111 FAINWAY DRIVE,SUITE 450, PALM BEACH GARDENS, FL, 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2015-11-04 | No data | CONVERSION MEMBER. RESULTING CORPORATION WAS L15000186549. CONVERSION NUMBER 500000155365 |
| AMENDMENT AND NAME CHANGE | 2013-11-07 | WOLVERINE ANESTHESIA CONSULTANTS, INC. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
