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  5. NORTHWEST FLORIDA SURGERY CENTER, INC.

NORTHWEST FLORIDA SURGERY CENTER, INC.

Company Details

Entity Name: NORTHWEST FLORIDA SURGERY CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 08 Sep 1992 (32 years ago)
Document Number: V63202
FEI/EIN Number 593123289
Address: 767 AIRPORT ROAD, PANAMA CITY, FL, 32405, US
Mail Address: 767 AIRPORT ROAD, PANAMA CITY, FL, 32405, US
ZIP code: 32405
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1992701049 2005-06-23 2008-04-20 767 AIRPORT RD, PANAMA CITY, FL, 324054000, US 767 AIRPORT RD, PANAMA CITY, FL, 324054000, US

Contacts
Phone +1 850-747-0400
Fax 8509139744

Authorized person
Name MR. RON NMI SAMUELIAN
Role CEO
Phone 8507470400

Taxonomy
Taxonomy Code 261QA1903X - Ambulatory Surgical Clinic/Center
License Number 0000745
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS
Number 62N
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2023 593123289 2024-03-11 NORTHWEST FLORIDA SURGERY CENTER 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2024-03-11
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2022 593123289 2023-04-28 NORTHWEST FLORIDA SURGERY CENTER 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2023-04-28
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2021 593123289 2022-04-14 NORTHWEST FLORIDA SURGERY CENTER 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2022-04-14
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2020 593123289 2021-05-05 NORTHWEST FLORIDA SURGERY CENTER 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2021-05-05
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2019 593123289 2020-07-02 NORTHWEST FLORIDA SURGERY CENTER 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2020-07-02
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2018 593123289 2019-03-13 NORTHWEST FLORIDA SURGERY CENTER 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2019-03-13
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2017 593123289 2018-04-03 NORTHWEST FLORIDA SURGERY CENTER 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2018-04-03
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-04-03
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2016 593123289 2017-02-28 NORTHWEST FLORIDA SURGERY CENTER 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2017-02-28
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-02-28
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2015 593123289 2016-02-28 NORTHWEST FLORIDA SURGERY CENTER 71
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2016-02-28
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST FLORIDA SURGERY CENTER 401(K) PLAN 2014 593123289 2015-05-01 NORTHWEST FLORIDA SURGERY CENTER 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621493
Sponsor’s telephone number 8507470400
Plan sponsor’s address 767 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2015-05-01
Name of individual signing RON SAMUELIAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Boyd Ginger Esq. Agent 215 S. MONROE ST., TALLAHASSEE, FL, 32301

Director

Name Role Address
TRAN QUANG Dr. Director 724 WEST 19TH STREET, PANAMA CITY, FL, 32405
Caspary Hans Dr. Director 724 West 19th Street, PANAMA CITY, FL, 32405

Vice President

Name Role Address
Caspary Hans Dr. Vice President 724 West 19th Street, PANAMA CITY, FL, 32405

Secretary

Name Role Address
SAMUELIAN RON Secretary 767 AIRPORT RD, PANAMA CITY, FL

President

Name Role Address
TRAN QUANG Dr. President 724 WEST 19TH STREET, PANAMA CITY, FL, 32405

Related by officers

SAMUELIAN RON

DOCTORS HEALTH CARE, L.L.C.

Boyd Ginger Esq.

NORTHWEST FLORIDA SURGERY CENTER, LTD.

Related by address

767 AIRPORT ROAD, PANAMA CITY, FL, 32405, US

PCWRC, INC.

767 AIRPORT ROAD, PANAMA CITY, FL, 32405, US

PCWRC, INC.

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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