| Entity Name: | GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Sep 2007 (17 years ago) |
| Document Number: | L07000092318 |
| FEI/EIN Number | 260868757 |
| Address: | 4120 WOODMERE PARK BLVD, VENICE, FL, 34293, US |
| Mail Address: | 4120 Woodmere Park Blvd, VENICE, FL, 34293, US |
| ZIP code: | 34293 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588087001 | 2014-02-04 | 2014-03-21 | 21300 GERTRUDE AVE, PORT CHARLOTTE, FL, 339525002, US | 21300 GERTRUDE AVE, PORT CHARLOTTE, FL, 339525002, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 941-408-6246 |
| Fax | 9412498956 |
Authorized person
| Name | MRS. LILLIANE M RODERIQUES |
| Role | OWNER |
| Phone | 9414086246 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | POR181 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0324051 00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RODERIQUES LILLIANE M | Agent | 4120 Woodmere Park Blvd., VENICE, FL, 34293 |
| Name | Role | Address |
|---|---|---|
| RODERIQUES KEITH A | Managing Member | 4120 Woodmere Park Blvd., VENICE, FL, 34293 |
| Name | Role | Address |
|---|---|---|
| RODERIQUES LILLIANE M | Manager | 4120 Woodmere Park Blvd., VENICE, FL, 34293 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2016-03-24 | 4120 WOODMERE PARK BLVD, SUITE 7, VENICE, FL 34293 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-24 | RODERIQUES, LILLIANE MOWNER | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-24 | 4120 Woodmere Park Blvd., Suite 7, VENICE, FL 34293 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-11-17 | 4120 WOODMERE PARK BLVD, SUITE 7, VENICE, FL 34293 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-16 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-27 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-02-16 |
| ANNUAL REPORT | 2016-03-24 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PURCHASE ORDER | AWARD | 36C25724K0856 | 2024-08-29 | 2025-02-27 | 2025-02-27 | |||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||
| Obligated Amount | 12345.18 |
| Current Award Amount | 12345.18 |
| Potential Award Amount | 12345.18 |
Description
| Title | EXPRESS REPORT: LIMB |
| NAICS Code | 339113: SURGICAL APPLIANCE AND SUPPLIES MANUFACTURING |
| Product and Service Codes | 6515: MEDICAL AND SURGICAL INSTRUMENTS, EQUIPMENT, AND SUPPLIES |
Recipient Details
| Recipient | GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC |
| UEI | TD1LV7WN5JB8 |
| Recipient Address | UNITED STATES, 4120 WOODMERE PARK BLVD STE 7, VENICE, SARASOTA, FLORIDA, 342935373 |
| Unique Award Key | CONT_AWD_36C24824P1928_3600_-NONE-_-NONE- |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 10707.30 |
| Current Award Amount | 10707.30 |
| Potential Award Amount | 10707.30 |
Description
| Title | PROS BK SCKT |
| NAICS Code | 339112: SURGICAL AND MEDICAL INSTRUMENT MANUFACTURING |
| Product and Service Codes | 6515: MEDICAL AND SURGICAL INSTRUMENTS, EQUIPMENT, AND SUPPLIES |
Recipient Details
| Recipient | GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC |
| UEI | TD1LV7WN5JB8 |
| Recipient Address | UNITED STATES, 4120 WOODMERE PARK BLVD STE 7, VENICE, SARASOTA, FLORIDA, 342935373 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
