| Entity Name: | COASTAL INTERVENTIONAL PAIN MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Aug 2009 (15 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L09000075260 |
| FEI/EIN Number | 270684976 |
| Address: | ST. ANTHONY HOSPITAL, MEDICAL OFFICE BLDG, #320, 1099 5TH AVE N, ST. PETERSBURG, FL, 33705 |
| Mail Address: | ST. ANTHONY HOSPITAL, MEDICAL OFFICE BLDG, #320, 1099 5TH AVE N, ST. PETERSBURG, FL, 33705 |
| ZIP code: | 33705 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962738567 | 2009-11-02 | 2011-03-03 | 1099 5TH AVE N, STE 320, ST PETERSBURG, FL, 337051469, US | 1099 5TH AVE N, STE 320, ST PETERSBURG, FL, 337051469, US | |||||||||||||||||||||
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| Phone | +1 727-822-7000 |
| Fax | 7278227001 |
Authorized person
| Name | JENNIFER M BURNS |
| Role | OWNER |
| Phone | 7278227000 |
Taxonomy
| Taxonomy Code | 261QP3300X - Pain Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BS FLORIDA |
| Number | 34087 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BURNS JENNIFER | Agent | ST ANTHONY HOSPITAL, ST. PETERSBURG, FL, 33705 |
| Name | Role | Address |
|---|---|---|
| BURNS JENNIFER | Managing Member | 1099 5TH AVENUE N #320, ST PETERSBURG, FL, 33705 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-05-04 | ST. ANTHONY HOSPITAL, MEDICAL OFFICE BLDG, #320, 1099 5TH AVE N, ST. PETERSBURG, FL 33705 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-12 |
| ANNUAL REPORT | 2010-05-04 |
| Florida Limited Liability | 2009-08-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
