| Entity Name: | PORT ORANGE GYNECOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Jan 2010 (15 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L10000005403 |
| FEI/EIN Number | 271697726 |
| Address: | 900 N. SWALLOWTAIL DRIVE, ST 102B, PORT ORANGE, FL, 32129 |
| Mail Address: | 900 N. SWALLOWTAIL DRIVE, ST 102B, PORT ORANGE, FL, 32129 |
| ZIP code: | 32129 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548600869 | 2013-07-01 | 2013-10-09 | PO BOX 12051, BELFAST, ME, 049154011, US | 900 N SWALLOWTAIL DR, ST 102B, PORT ORANGE, FL, 321296102, US | |||||||||||||||||||||||||
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| Phone | +1 386-492-6929 |
| Fax | 3864926930 |
Authorized person
| Name | PAULA M. FOUST |
| Role | M.D. OWNER |
| Phone | 3864926929 |
Taxonomy
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| License Number | ME97528 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277730400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FOUST PAULA MMD | Agent | 400 Rio Grande, Edgewater, FL, 32141 |
| Name | Role | Address |
|---|---|---|
| FOUST PAULA MMD | Managing Member | 400 Rio Grande, Edgewater, FL, 32141 |
| Name | Role | Address |
|---|---|---|
| Foust Alexandra | Auth | 4932 Jay St NE, Washington, FL, 20019 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-19 | 400 Rio Grande, Edgewater, FL 32141 | No data |
| REINSTATEMENT | 2014-10-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2013-02-21 | No data | No data |
| PENDING REINSTATEMENT | 2013-02-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-02-21 | 900 N. SWALLOWTAIL DRIVE, ST 102B, PORT ORANGE, FL 32129 | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-21 | 900 N. SWALLOWTAIL DRIVE, ST 102B, PORT ORANGE, FL 32129 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-06-03 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-09 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-03-18 |
| REINSTATEMENT | 2014-10-02 |
| REINSTATEMENT | 2013-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
