| Entity Name: | BOCA MEDICAL SPECIALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Sep 1999 (25 years ago) |
| Document Number: | P99000083960 |
| FEI/EIN Number | 650951322 |
| Mail Address: | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919, US |
| Address: | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL, 33323, US |
| ZIP code: | 33323 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265453419 | 2006-07-22 | 2017-12-06 | 5870 HIATUS RD STE 200, TAMARAC, FL, 333216424, US | 5870 HIATUS RD STE 200, TAMARAC, FL, 333216424, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-377-3172 |
| Fax | 8775194595 |
| Phone | +1 561-588-4844 |
| Fax | 5615884844 |
Authorized person
| Name | MR. STEPHEN G HOLTZCLAW |
| Role | PRESIDENT |
| Phone | 8652935310 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002107800 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| UPPAL ROHIT M | Director | 1643 NW 136TH AVE, Sunrise, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| STAIR JOHN | ASSI | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| BARRACK JOHN | ASSI | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Corvini Michael | Vice President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Evans Rob | Vice President | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Name | Role | Address |
|---|---|---|
| Leone Alice M | Treasurer | 265 BROOKVIEW CENTRE WAY, SUITE 203, KNOXVILLE, TN, 37919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-08 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-12 | 1643 NW 136TH AVE, BUILDING H, SUITE 100, Sunrise, FL 33323 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-11-09 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-11-09 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-06-26 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-04-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
