| Entity Name: | COASTAL MEDICAL ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 14 Jun 1989 (36 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | K95378 |
| FEI/EIN Number | 59-2952811 |
| Address: | 4530 S RIDGEWOOD AVE, PORT ORANGE, FL 32127 |
| Mail Address: | 1055 N Dixie Freeway, Suite 1, New Smyrna Beach, FL 32168 |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902893795 | 2005-10-05 | 2009-07-24 | 4530 S RIDGEWOOD AVE, PORT ORANGE, FL, 321274523, US | 4530 S RIDGEWOOD AVE, PORT ORANGE, FL, 321274523, US | |||||||||||||||||||||||||
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| Phone | +1 386-788-1881 |
| Fax | 3867888556 |
Authorized person
| Name | MRS. BETSY JOAN LEVIN |
| Role | PRESIDENT |
| Phone | 3867881881 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 374426400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ailani, Rajesh K | Agent | 1055 N Dixie Freeway, Suite 1, New Smyrna Beach, FL 32168 |
| Name | Role | Address |
|---|---|---|
| Ailani, Rajesh K | Owner | 1055 N Dixie Freeway, Suite 1 New Smyrna Beach, FL 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2015-02-16 | 4530 S RIDGEWOOD AVE, PORT ORANGE, FL 32127 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-02-16 | Ailani, Rajesh K | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-16 | 1055 N Dixie Freeway, Suite 1, New Smyrna Beach, FL 32168 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-03-01 | 4530 S RIDGEWOOD AVE, PORT ORANGE, FL 32127 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2015-02-16 |
| ANNUAL REPORT | 2015-01-19 |
| ANNUAL REPORT | 2014-01-08 |
| ANNUAL REPORT | 2013-01-25 |
| ANNUAL REPORT | 2012-01-26 |
| ANNUAL REPORT | 2011-01-04 |
| ANNUAL REPORT | 2010-03-01 |
| ANNUAL REPORT | 2009-06-22 |
| ANNUAL REPORT | 2008-03-12 |
| ANNUAL REPORT | 2007-02-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
