| Entity Name: | EMERALD COAST INTERNAL MEDICINE AND GERIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 May 2014 (11 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L14000077083 |
| FEI/EIN Number | 46-5643114 |
| Address: | 2810 Highway 77, PANAMA CITY, FL, 32405, US |
| Mail Address: | PO BOX 419, LYNN HAVEN, FL, 32444, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114339074 | 2014-05-27 | 2014-09-24 | PO BOX 419, LYNN HAVEN, FL, 324440419, US | 280 FOREST PARK CIR, PANAMA CITY, FL, 324054919, US | |||||||||||||||||||
|
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| Phone | +1 850-896-9688 |
| Fax | 8507697717 |
Authorized person
| Name | DR. EMAD A EISA |
| Role | MEDICAL DOCTOR |
| Phone | 7035986013 |
Taxonomy
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| License Number | ME114732 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| EISA EMAD A | Agent | 2810 Highway 77, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| EISA EMAD ADr. | Mang | 2810 Highway 77, PANAMA CITY, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REINSTATEMENT | 2019-01-10 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-09-27 | EISA, EMAD A | No data |
| REINSTATEMENT | 2017-09-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-07-08 | 2810 Highway 77, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-07-08 | 2810 Highway 77, PANAMA CITY, FL 32405 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2019-01-10 |
| REINSTATEMENT | 2017-09-27 |
| ANNUAL REPORT | 2016-07-08 |
| ANNUAL REPORT | 2015-06-11 |
| Florida Limited Liability | 2014-05-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
