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  5. SOUTH DADE NEONATOLOGY, LLC

SOUTH DADE NEONATOLOGY, LLC

Company Details

Entity Name: SOUTH DADE NEONATOLOGY, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 06 Jul 2012 (13 years ago)
Date of dissolution: 12 Dec 2022 (2 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 12 Dec 2022 (2 years ago)
Document Number: L12000088792
FEI/EIN Number 65-0942365
Address: 215 GRAND AVENUE, CORAL GABLES, FL, 33133
Mail Address: 215 GRAND AVENUE, CORAL GABLES, FL, 33133
ZIP code: 33133
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1841369006 2006-11-06 2011-01-27 PO BOX 43-2620, SOUTH MIAMI, FL, 332432620, US 215 GRAND AVE, CORAL GABLES, FL, 331334841, US

Contacts
Phone +1 305-441-7179
Fax 3054487134

Authorized person
Name ERNESTO VALDES
Role PARTNER
Phone 3054417179

Taxonomy
Taxonomy Code 2080N0001X - Neonatal-Perinatal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer BC BS
Number 38734
State FL
Issuer MEDICAID
Number 256644300
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2019 650942365 2020-07-09 SOUTH DADE NEONATOLOGY 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2018 650942365 2019-08-15 SOUTH DADE NEONATOLOGY 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2019-08-15
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2017 650942365 2018-09-13 SOUTH DADE NEONATOLOGY 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2018-09-13
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2016 650942365 2017-09-14 SOUTH DADE NEONATOLOGY 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2017-09-14
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2015 650942365 2016-09-13 SOUTH DADE NEONATOLOGY 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2016-09-13
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2014 650942365 2015-09-22 SOUTH DADE NEONATOLOGY 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2015-09-22
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2013 650942365 2014-08-04 SOUTH DADE NEONATOLOGY 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Signature of
Role Plan administrator
Date 2014-08-04
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2012 650942365 2013-10-04 SOUTH DADE NEONATOLOGY 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Plan administrator’s name and address
Administrator’s EIN 650942365
Plan administrator’s name SOUTH DADE NEONATOLOGY
Plan administrator’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133
Administrator’s telephone number 3054417179

Signature of
Role Plan administrator
Date 2013-10-04
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2011 650942365 2012-10-09 SOUTH DADE NEONATOLOGY 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Plan administrator’s name and address
Administrator’s EIN 650942365
Plan administrator’s name SOUTH DADE NEONATOLOGY
Plan administrator’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133
Administrator’s telephone number 3054417179

Signature of
Role Plan administrator
Date 2012-10-09
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature
SOUTH DADE NEONATOLOGY 401(K) PROFIT SHARING PLAN 2010 650942365 2011-10-04 SOUTH DADE NEONATOLOGY 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3054417179
Plan sponsor’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Plan administrator’s name and address
Administrator’s EIN 650942365
Plan administrator’s name SOUTH DADE NEONATOLOGY
Plan administrator’s address 215 GRAND AVENUE, CORAL GABLES, FL, 33133
Administrator’s telephone number 3054417179

Signature of
Role Plan administrator
Date 2011-10-04
Name of individual signing ALEX KOETZLE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KOETZLE ALEX B Agent 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Manager

Name Role Address
COSTA OMAR J Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133
CAMPO MANUEL A Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133
PIMENTEL BERNARDO M Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133
DIAZ-MONROIG GISELA M Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133
VALDES ERNESTO M Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133
KOETZLE ALEX J Manager 215 GRAND AVENUE, CORAL GABLES, FL, 33133

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2022-12-12 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2022-12-12
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-03-31
ANNUAL REPORT 2020-06-22
ANNUAL REPORT 2019-05-01
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-21
ANNUAL REPORT 2016-04-03
ANNUAL REPORT 2015-02-28
ANNUAL REPORT 2014-01-29

Related by officers

COSTA OMAR J

COASTLAND MORTGAGE CORP. COASTLAND REALTY GROUP INC.

VALDES ERNESTO M

ERNESTO VALDES, M. D., P. A. BOCA PEDIATRIC CRITICAL CARE, P.A.

KOETZLE ALEX B

J. L. DALY, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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