| Entity Name: | WATERSIDE MEDICAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
WATERSIDE MEDICAL LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 17 Dec 2012 (12 years ago) |
| Date of dissolution: | 25 Sep 2015 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (10 years ago) |
| Document Number: | L12000157219 |
| FEI/EIN Number |
46-1600132
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 2950 9th St. North,, Naples, FL, 34103, US |
| Mail Address: | 2950 9th St. North,, Naples, FL, 34103, US |
| ZIP code: | 34103 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518205038 | 2013-01-17 | 2013-08-22 | 5064 SEASHELL AVE, NAPLES, FL, 341032428, US | 311 9TH ST N, NAPLES, FL, 341025885, US | |||||||||||||||||||||||||
|
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| Phone | +1 239-293-4140 |
| Fax | 2392543105 |
Authorized person
| Name | MATTHEW L BLACK |
| Role | MANAGER |
| Phone | 2392934140 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | M80046 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE 855-B |
| Number | HG441A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLACK MATTHEW L | Manager | 2950 9th St. North,, Naples, FL, 34103 |
| Black Matthew L | Agent | 2950 9TH STREET NORTH STE 13, NAPLES, FL, 34103 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000067817 | WATERSIDE MEDICAL, LLC. | EXPIRED | 2013-07-05 | 2018-12-31 | - | 5064 SEASHELL AVE., NAPLES, FL, 34103 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-06 | 2950 9th St. North,, Suite 13, Naples, FL 34103 | - |
| CHANGE OF MAILING ADDRESS | 2014-01-06 | 2950 9th St. North,, Suite 13, Naples, FL 34103 | - |
| LC STMNT OF RA/RO CHG | 2014-01-02 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-02 | 2950 9TH STREET NORTH STE 13, NAPLES, FL 34103 | - |
| REGISTERED AGENT NAME CHANGED | 2013-04-05 | Black, Matthew L | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-01-09 |
| CORLCRACHG | 2014-01-02 |
| ANNUAL REPORT | 2013-04-05 |
| Florida Limited Liability | 2012-12-17 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
