Entity Name: | SPACE COAST MEDICAL, LLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Co. |
Status: | Active |
Date Filed: | 01 Aug 2011 (14 years ago) |
Last Event: | LC AMENDMENT |
Event Date Filed: | 27 Mar 2024 (a year ago) |
Document Number: | L11000088035 |
FEI/EIN Number | 453716351 |
Address: | 2069 MOBILAND DR., MELBOURNE, FL, 32935, US |
Mail Address: | 2069 MOBILAND DR., MELBOURNE, FL, 32935, US |
ZIP code: | 32935 |
County: | Brevard |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1376807511 | 2012-07-03 | 2015-07-28 | 4295 N US HIGHWAY 1, MELBOURNE, FL, 329354822, US | 935 BAREFOOT BLVD, BLDG 1 SUITE 2, BAREFOOT BAY, FL, 329767620, US | |||||||||||||||||||||||||
|
Phone | +1 321-557-4667 |
Authorized person
Name | JASON LAIL |
Role | C.E.O. |
Phone | 3215574667 |
Taxonomy
Taxonomy Code | 208D00000X - General Practice Physician |
License Number | OS6898 |
State | FL |
Is Primary | No |
Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
Is Primary | No |
Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
YANCEY GINA | Agent | 2069 MOBILAND DR., MELBOURNE, FL, 32935 |
Name | Role | Address |
---|---|---|
LAIL JASON | Manager | 2069 MOBILAND DR., MELBOURNE, FL, 32935 |
YANCEY GINA L | Manager | 585 ORANGE GROVE AVE., MELBOURNE, FL, 32904 |
Name | Role | Address |
---|---|---|
YANCEY GINA L | Officer | 585 ORANGE GROVE AVE., MELBOURNE, FL, 32904 |
Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
---|---|---|---|---|---|---|
G17000009132 | SPACE COAST MEDICAL CONSULTING | EXPIRED | 2017-01-25 | 2022-12-31 | No data | 4295 N. US HWY 1, MELBOURNE, FL, 32935 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
REGISTERED AGENT ADDRESS CHANGED | 2024-03-27 | 2069 MOBILAND DR., MELBOURNE, FL 32935 | No data |
LC AMENDMENT | 2024-03-27 | No data | No data |
REGISTERED AGENT NAME CHANGED | 2024-03-27 | YANCEY, GINA | No data |
LC AMENDMENT | 2024-03-19 | No data | No data |
CHANGE OF PRINCIPAL ADDRESS | 2024-03-19 | 2069 MOBILAND DR., MELBOURNE, FL 32935 | No data |
CHANGE OF MAILING ADDRESS | 2024-03-19 | 2069 MOBILAND DR., MELBOURNE, FL 32935 | No data |
LC AMENDMENT | 2022-12-22 | No data | No data |
REINSTATEMENT | 2015-09-28 | No data | No data |
ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
Name | Date |
---|---|
LC Amendment | 2024-03-27 |
LC Amendment | 2024-03-19 |
ANNUAL REPORT | 2024-02-29 |
ANNUAL REPORT | 2023-02-27 |
LC Amendment | 2022-12-22 |
ANNUAL REPORT | 2022-04-20 |
ANNUAL REPORT | 2021-01-15 |
ANNUAL REPORT | 2020-03-03 |
ANNUAL REPORT | 2019-01-17 |
ANNUAL REPORT | 2018-03-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State