| Entity Name: | COASTAL INTERNAL MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Apr 2014 (11 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 14 Aug 2020 (4 years ago) |
| Document Number: | L14000063275 |
| FEI/EIN Number | 35-2506005 |
| Address: | 12007 Panama City Beach Pkwy, Panama City Beach, FL, 32407, US |
| Mail Address: | 12007 Panama City Beach Pkwy, Panama City Beach, FL, 32407, US |
| ZIP code: | 32407 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184163909 | 2017-02-13 | 2017-02-13 | 12007 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL, 324072607, US | 12007 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL, 324072607, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 850-234-5151 |
| Fax | 8502343303 |
Authorized person
| Name | DR. ISMAIL ZABIH |
| Role | PRESIDENT |
| Phone | 8502345151 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME85390 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COASTAL INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST | 2015 | 593757787 | 2016-06-24 | COASTAL INTERNAL MEDICINE | 30 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2016-06-24 |
| Name of individual signing | SUSAN MAROTTE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3866723219 |
| Plan sponsor’s address | 335 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2015-06-25 |
| Name of individual signing | MARY LASTARZA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3866723219 |
| Plan sponsor’s address | 335 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-15 |
| Name of individual signing | SUSAN MAROTTE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3866723219 |
| Plan sponsor’s address | 335 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-09 |
| Name of individual signing | COASTAL INTERNAL MEDICINE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ZABIH ISMAIL MD | Agent | 12007 Panama City Beach Pkwy, Panama City Beach, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| Zabih Ismail Dr. | President | 12007 Panama City Beach Pkwy, Panama City Beach, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| Ismail Zabih, M.D. | Auth | 12007 Panama City Beach Parkway, Panama City Beach, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| ZABIH ISMAIL MD | Authorized Member | 12007 Panama City Beach Pkwy, Panama City Beach, FL, 32407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2020-08-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-08-14 | ZABIH, ISMAIL, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-14 | 12007 Panama City Beach Pkwy, Panama City Beach, FL 32407 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-24 | 12007 Panama City Beach Pkwy, Panama City Beach, FL 32407 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-31 | 12007 Panama City Beach Pkwy, Panama City Beach, FL 32407 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-01 |
| LC Amendment | 2020-08-14 |
| ANNUAL REPORT | 2020-02-11 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-03-08 |
| ANNUAL REPORT | 2017-01-31 |
| ANNUAL REPORT | 2016-03-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
