| Entity Name: | INVERNESS SURGICAL ASSOCIATION, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Dec 1999 (25 years ago) |
| Date of dissolution: | 15 Apr 2013 (12 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 15 Apr 2013 (12 years ago) |
| Document Number: | P99000105736 |
| FEI/EIN Number | 593613043 |
| Address: | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452, US |
| Mail Address: | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452, US |
| ZIP code: | 34452 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790752863 | 2006-03-07 | 2011-01-25 | 403 W HIGHLAND BLVD, INVERNESS, FL, 344524717, US | 403 W HIGHLAND BLVD, INVERNESS, FL, 344524717, US | |||||||||||||||||||||||||||||||
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| Phone | +1 352-726-3646 |
| Fax | 3527260079 |
Authorized person
| Name | MARC E FERNANDEZ |
| Role | OFFICER/SECRETARY |
| Phone | 3527263646 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 80110207817 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS GROUP |
| Number | 38905 |
| State | FL |
| Issuer | MEDICAID |
| Number | 258062400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PHAM QUEHUONG HMD | Agent | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| DAVIS TERRI G | Secretary | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| DAVIS TERRI G | Treasurer | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| FERNANDEZ MARC EMD | President | 403 W. HIGHLAND BLVD, INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| PHAM QUEHUONG HMD | Vice President | 403 W. HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2013-04-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-17 | 403 W. HIGHLAND BLVD., INVERNESS, FL 34452 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-17 | 403 W. HIGHLAND BLVD., INVERNESS, FL 34452 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-02-17 | PHAM, QUEHUONG H, MD | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2013-04-15 |
| ANNUAL REPORT | 2012-04-17 |
| ANNUAL REPORT | 2011-04-26 |
| ANNUAL REPORT | 2010-02-17 |
| ANNUAL REPORT | 2009-04-30 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-04-25 |
| ANNUAL REPORT | 2006-02-14 |
| ANNUAL REPORT | 2005-07-12 |
| ANNUAL REPORT | 2004-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
