| Entity Name: | COGENT HEALTHCARE OF FORT MYERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 19 Jun 2002 (23 years ago) |
| Date of dissolution: | 07 Nov 2017 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 07 Nov 2017 (7 years ago) |
| Document Number: | L02000015338 |
| FEI/EIN Number | 75-3067930 |
| Address: | 1498 PACIFIC AVE, SUITE 400, TACOMA, WA 98402 |
| Mail Address: | 1498 PACIFIC AVE, SUITE 400, TACOMA, WA 98402 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952352163 | 2006-05-12 | 2008-07-21 | 5410 MARYLAND WAY, SUITE 300, BRENTWOOD, TN, 370275064, US | 2776 CLEVELAND AVE, CARE MANAGEMENT DEPARTMENT, 8TH FLOOR, FT MYERS, FL, 339015864, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 615-377-5670 |
| Fax | 6153771687 |
| Phone | +1 239-344-5837 |
Authorized person
| Name | SUSAN A. BROWNIE |
| Role | TREASURER |
| Phone | 6153775630 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266101200 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHEILD FL |
| Number | 34480 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BESSLER, ROBERT A | PRESIDENT | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| Name | Role | Address |
|---|---|---|
| BESSLER, ROBERT A | DIRECTOR | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| Name | Role | Address |
|---|---|---|
| NICHOLAS, COOK | Asst. Secretary | 5410 MARYLAND WAY STE 300, BRENTWOOD, TN 37027 |
| Name | Role | Address |
|---|---|---|
| MCCARTY, STEVEN | Secretary | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| Name | Role | Address |
|---|---|---|
| BRINK, PETER | TREASURER | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| Name | Role | Address |
|---|---|---|
| CAPUTO, MARK | Authorized Member | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| KUERBITZ, RONALD | Authorized Member | 1498 PACIFIC AVE, SUITE 400 TACOMA, WA 98402 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-11-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-21 | 1498 PACIFIC AVE, SUITE 400, TACOMA, WA 98402 | No data |
| CHANGE OF MAILING ADDRESS | 2016-01-21 | 1498 PACIFIC AVE, SUITE 400, TACOMA, WA 98402 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-09-09 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-09-09 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-01-21 |
| ANNUAL REPORT | 2015-03-25 |
| ANNUAL REPORT | 2014-01-15 |
| ANNUAL REPORT | 2013-04-01 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-02-18 |
| ANNUAL REPORT | 2009-01-22 |
| ANNUAL REPORT | 2008-04-14 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
