| Entity Name: | THE KOLETTIS KREW, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Sep 2002 (22 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 04 Sep 2006 (18 years ago) |
| Document Number: | L02000025324 |
| FEI/EIN Number | 753083011 |
| Address: | 701 N. Hercules Avenue, CLEARWATER, FL, 33765, US |
| Mail Address: | 14708 SAN MARSALA COURT, TAMPA, FL, 33626 |
| ZIP code: | 33765 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457533762 | 2007-11-28 | 2016-03-24 | 701 N. HERCULES AVE, STE. B, CLEARWATER, FL, 337652029, US | 701 N. HERCULES AVE, STE B, CLEARWATER, FL, 337652029, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 727-738-8410 |
| Fax | 7277346254 |
Authorized person
| Name | DR. ELIAS M KOLETTIS |
| Role | PHYSICIAN |
| Phone | 7277388410 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | OS0007623 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 46556 |
| State | FL |
| Issuer | AETNA |
| Number | 2161129 |
| State | FL |
| Issuer | MEDICAID |
| Number | 255469100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Kolettis Elias MDr. | Agent | 701 N. Hercules Avenue, CLEARWATER, FL, 33765 |
| Name | Role | Address |
|---|---|---|
| KOLETTIS ELIAS M | Manager | 701 N. Hercules Avenue, CLEARWATER, FL, 33765 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-20 | 701 N. Hercules Avenue, Suite B, CLEARWATER, FL 33765 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-20 | 701 N. Hercules Avenue, Suite B, CLEARWATER, FL 33765 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-09-13 | Kolettis, Elias M, Dr. | No data |
| CANCEL ADM DISS/REV | 2006-09-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2003-04-15 | 701 N. Hercules Avenue, Suite B, CLEARWATER, FL 33765 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-04-03 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-06-02 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-01 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-03-20 |
| ANNUAL REPORT | 2015-02-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
