| Entity Name: | SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Oct 1969 (55 years ago) |
| Document Number: | 601586 |
| FEI/EIN Number | 591273247 |
| Address: | 13644 WALSINGHAM RD., LARGO, FL, 33774, US |
| Mail Address: | 13644 WALSINGHAM RD., LARGO, FL, 33774, US |
| ZIP code: | 33774 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710031984 | 2007-01-23 | 2012-05-30 | 13644 WALSINGHAM ROAD, S.R. #688, LARGO, FL, 337743532, US | 13644 WALSINGHAM ROAD, S.R. #688, LARGO, FL, 337743532, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-595-2519 |
| Fax | 7274790485 |
Authorized person
| Name | DR. SUSAN L ZITO |
| Role | GENERAL PRACTITIONER/PARTNER |
| Phone | 7275952519 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 77021 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 059638800 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | CK1058 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A. 401(K) PROFIT SHARING PLAN | 2009 | 591273247 | 2010-07-29 | SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A. | 49 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 591273247 |
| Plan administrator’s name | SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A. |
| Plan administrator’s address | 13644 WALSINGHAM ROAD, LARGO, FL, 33774 |
| Administrator’s telephone number | 7275952519 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-29 |
| Name of individual signing | ANTHONY N. OTTAVIANI, D.O. |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-07-29 |
| Name of individual signing | ANTHONY N. OTTAVIANI, D.O. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Marquardt J. Matthew Esq. | Agent | 625 Court Street, Clearwater, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| DIGIOVANNI ROBERT L | President | 13644 WASHINGHAM ROAD, LARGO, FL, 33774 |
| Name | Role | Address |
|---|---|---|
| MAXFIELD DANE L | TDSD | 13644 WASHINGHAM ROAD, LARGO, FL, 33774 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2013-11-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| NAME CHANGE AMENDMENT | 1997-09-03 | SUNCOAST INTERNAL MEDICINE CONSULTANTS, P.A. | No data |
| NAME CHANGE AMENDMENT | 1979-08-21 | SUNCOAST INTERNAL MEDICINE CONSULTANTS, DRS. KOTSCH, WINGFIELD, KUDELKO, OTTAVIANI AND MAXFIELD, D.O. PROFESSIONAL ASSOCIATION | No data |
| NAME CHANGE AMENDMENT | 1972-08-29 | GEORGE KOTSCH, D.O., C. DAVID WINGFIELD, D.0., AND PAUL E. KUDELKO D.O., PROFESSIONAL ASSOCIATION | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000361370 | LAPSED | 17-000110-CI | PINELLAS COUNTY, FL | 2017-06-19 | 2022-06-26 | $2,285,206.80 | ASD SPECIALTY HEALTHCARE, INC. DBA BESSE MEDICAL SUPPLY, 9075 CENTRE POINTE DRIVE, SUITE 140, WEST CHESTER, OH 45069 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
