| Entity Name: | GULF COAST KIDNEY ASSOCIATES, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Mar 2002 (23 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 31 Mar 2016 (9 years ago) |
| Document Number: | L02000005390 |
| FEI/EIN Number | 800031974 |
| Address: | 1921 WALDMERE STREET, SUITE 306, SARASOTA, FL, 34239, US |
| Mail Address: | 1921 WALDMERE STREET, SUITE 306, SARASOTA, FL, 34239, US |
| ZIP code: | 34239 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962467373 | 2006-04-19 | 2010-05-24 | 1921 WALDEMERE ST, SUITE 306, SARASOTA, FL, 342392943, US | 1921 WALDEMERE ST, SUITE 306, SARASOTA, FL, 342392943, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 941-917-8722 |
| Fax | 9419178727 |
Authorized person
| Name | DR. ANDREW L. LAZIN |
| Role | STAFF PHYSICIAN |
| Phone | 9419178722 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 254520001 |
| State | FL |
| Issuer | MEDICAID |
| Number | 254542000 |
| State | FL |
| Issuer | BCBS |
| Number | 38341 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VANBUSKIRK TODD T | Agent | 333 TAMIAMI TRAIL SOUTH, VENICE, FL, 34285 |
| Name | Role | Address |
|---|---|---|
| DENNIS IMPERIO MD PA | Manager | 6825 TALLMAST CIR, BRADENTON, FL, 34202 |
| JANIS LAWRENCE-JACKSON, D.O., P.A. | Manager | No data |
| Kalakurthy Samantha MD PA | Manager | 1921 Waldemere Street, Sarasota, FL, 34239 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2016-03-31 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-24 | VANBUSKIRK, TODD T | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-24 | 333 TAMIAMI TRAIL SOUTH, SUITE 257, VENICE, FL 34285 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-16 | 1921 WALDMERE STREET, SUITE 306, SARASOTA, FL 34239 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-16 | 1921 WALDMERE STREET, SUITE 306, SARASOTA, FL 34239 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-28 |
| ANNUAL REPORT | 2023-02-11 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-02-09 |
| ANNUAL REPORT | 2017-02-23 |
| LC Amendment | 2016-03-31 |
| ANNUAL REPORT | 2016-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
