| Entity Name: | EMERALD COAST OBGYN, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 15 Jun 1982 (43 years ago) |
| Document Number: | F85427 |
| FEI/EIN Number | 592195254 |
| Address: | EMERALD COAST OBGYN, INC., 103 EAST 23RD ST, PANAMA CITY, FL, 32405 |
| Mail Address: | EMERALD COAST OBGYN, INC., 103 EAST 23RD ST, PANAMA CITY, FL, 32405 |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598712770 | 2006-05-31 | 2011-07-21 | 103 E 23RD ST, PANAMA CITY, FL, 324054501, US | 103 E 23RD ST, PANAMA CITY, FL, 324054501, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 850-769-0338 |
| Fax | 8507856088 |
Authorized person
| Name | MR. GARY COX |
| Role | OFFICE ADMINISTRATOR |
| Phone | 8507690338 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373548600 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMERALD COAST OBGYN, INC. PROFIT SHARING PLAN | 2010 | 592195254 | 2011-03-25 | EMERALD COAST OBGYN, INC. | 46 | |||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||
| Administrator’s EIN | 592195254 |
| Plan administrator’s name | EMERALD COAST OBGYN, INC. |
| Plan administrator’s address | 2250 JENKS AVENUE, SUITE A, PANAMA CITY, FL, 324054681 |
| Administrator’s telephone number | 8507690338 |
Signature of
| Role | Plan administrator |
| Date | 2011-03-25 |
| Name of individual signing | MICHAEL A INGRAM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 1994-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8507690338 |
| Plan sponsor’s address | 2250 JENKS AVENUE, SUITE A, PANAMA CITY, FL, 324054681 |
Plan administrator’s name and address
| Administrator’s EIN | 592195254 |
| Plan administrator’s name | EMERALD COAST OBGYN, INC. |
| Plan administrator’s address | 2250 JENKS AVENUE, SUITE A, PANAMA CITY, FL, 324054681 |
| Administrator’s telephone number | 8507690338 |
Signature of
| Role | Plan administrator |
| Date | 2010-05-10 |
| Name of individual signing | MICHAEL A INGRAM |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-05-10 |
| Name of individual signing | MICHAEL A INGRAM |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 1994-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8507690338 |
| Plan sponsor’s address | 2250 JENKS AVENUE, SUITE A, PANAMA CITY, FL, 324054681 |
Plan administrator’s name and address
| Administrator’s EIN | 592195254 |
| Plan administrator’s name | EMERALD COAST OBGYN, INC. |
| Plan administrator’s address | 2250 JENKS AVENUE, SUITE A, PANAMA CITY, FL, 324054681 |
| Administrator’s telephone number | 8507690338 |
Signature of
| Role | Plan administrator |
| Date | 2010-05-04 |
| Name of individual signing | MICHAEL A. INGRAM |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-05-04 |
| Name of individual signing | MICHAEL A. INGRAM |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| Name | Role | Address |
|---|---|---|
| BRELAND HENRY B | Agent | 103 E 23RD ST, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| BRELAND HENRY B | President | 103 E 23RD ST, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| RAMIE GEORGE B | Vice President | 103 E 23RD ST, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| WOLF SAMUEL B | Treasurer | 103 E 23RD ST, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| PENNINGTON TONI L | Shar | 103 E 23RD ST, PANAMA CITY, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-03-03 | No data | No data |
| NAME CHANGE AMENDMENT | 2004-09-14 | EMERALD COAST OBGYN, INC. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
