| Entity Name: | ANESTHESIOLOGY PROFESSIONAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jul 1999 (25 years ago) |
| Document Number: | P99000067993 |
| FEI/EIN Number | 593589566 |
| Address: | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US |
| Mail Address: | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902856891 | 2006-05-11 | 2018-06-19 | 4919 MEMORIAL HWY STE 200, TAMPA, FL, 336347500, US | 4919 MEMORIAL HWY STE 200, TAMPA, FL, 33634, US | |||||||||||||||||||||
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| Phone | +1 813-569-6500 |
| Fax | 8138644030 |
Authorized person
| Name | JEFF D. PARKS |
| Role | SENIOR VICE PRESIDENT |
| Phone | 8135696500 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 262401000 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| KENNEDY BRETT | Vice President | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027 |
| DOHERTY DAVE | Vice President | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027 |
| O'BRIEN JEFF | Vice President | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027 |
| BALDOCK JENNIFER | Vice President | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08312900229 | ANESTHESIA PROFESSIONAL SERVICES | EXPIRED | 2008-11-07 | 2013-12-31 | No data | 5501 W. GRAY ST, TAMPA, FL, 33609 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
