| Entity Name: | SANDFORD H. KINNE, III, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Apr 1999 (26 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Dec 2018 (6 years ago) |
| Document Number: | P99000033728 |
| FEI/EIN Number | 593573926 |
| Address: | 3 Willow Ct, Ormond Beach, FL, 32174, US |
| Mail Address: | 3 Willow Ct, ORMOND BEACH, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942435920 | 2009-05-20 | 2009-05-20 | PO BOX 731869, ORMOND BEACH, FL, 321731869, US | 290 CLYDE MORRIS BLVD, SUITE A-1, ORMOND BEACH, FL, 321748130, US | |||||||||||||||||||||||||
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| Phone | +1 386-677-5600 |
| Fax | 3866775686 |
Authorized person
| Name | DR. SANDFORD HALSEY KINNE III |
| Role | OWNER/SELF |
| Phone | 3866775600 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS0006791 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 375409000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Sandford H Kinne D.O., P.A. | Agent | 11 Riverside Dr, Holly Hill, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| KINNE SANDFORD HIII | President | 3 WILLOW CT, ORMOND BEACH, FL, 32174 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2018-12-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-12-12 | 3 Willow Ct, Ormond Beach, FL 32174 | No data |
| CHANGE OF MAILING ADDRESS | 2018-12-12 | 3 Willow Ct, Ormond Beach, FL 32174 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-26 | 11 Riverside Dr, Holly Hill, FL 32117 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-23 | Sandford H Kinne D.O., P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-03-04 |
| ANNUAL REPORT | 2019-01-31 |
| REINSTATEMENT | 2018-12-12 |
| ANNUAL REPORT | 2016-03-26 |
| ANNUAL REPORT | 2015-04-23 |
| ANNUAL REPORT | 2014-02-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
