| Entity Name: | COLLIER HEART GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 24 May 2005 (20 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L05000051714 |
| FEI/EIN Number | 202901023 |
| Address: | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102, US |
| Mail Address: | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102, US |
| ZIP code: | 34102 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104881341 | 2006-04-19 | 2008-04-20 | PO BOX 850001, ORLANDO, FL, 328850001, US | 311 9TH ST N, SUITE 304, NAPLES, FL, 341025885, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 239-659-0102 |
| Fax | 2396590108 |
Authorized person
| Name | DR. DAVID R. AXLINE |
| Role | PARTNER |
| Phone | 2396590102 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | No |
| Taxonomy Code | 207RI0011X - Interventional Cardiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 00793 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DE1357 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COLLIER HEART GROUP PROFIT SHARING PLAN | 2010 | 202901023 | 2011-02-18 | COLLIER HEART GROUP, PLLC | 19 | |||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||
| Administrator’s EIN | 202901023 |
| Plan administrator’s name | COLLIER HEART GROUP, PLLC |
| Plan administrator’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Administrator’s telephone number | 2392615330 |
Signature of
| Role | Plan administrator |
| Date | 2011-02-18 |
| Name of individual signing | CARLO SANTOS-OCAMPO |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-02-18 |
| Name of individual signing | CARLO SANTOS-OCAMPO |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2392615330 |
| Plan sponsor’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
Plan administrator’s name and address
| Administrator’s EIN | 202901023 |
| Plan administrator’s name | COLLIER HEART GROUP, PLLC |
| Plan administrator’s address | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Administrator’s telephone number | 2392615330 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-21 |
| Name of individual signing | DAVID AXLINE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-07-21 |
| Name of individual signing | DAVID AXLINE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BLALOCK, WALTERS, HELD & JOHNSON, P.A. | Agent | 802 11TH STREET WEST, BRADENTON, FL, 34205 |
| Name | Role | Address |
|---|---|---|
| AXLINE DAVID R | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| SANTOS-OCAMPO CARLO D | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| SPILKER HERMAN L | Managing Member | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL, 34102 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-09-01 | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL 34102 | No data |
| CHANGE OF MAILING ADDRESS | 2025-09-01 | 311 9TH STREET NORTH, SUITE 304, NAPLES, FL 34102 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-28 |
| ANNUAL REPORT | 2009-04-21 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-04-26 |
| ANNUAL REPORT | 2006-04-25 |
| Florida Limited Liability | 2005-05-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
