| Entity Name: | FIRST COAST MEDICAL ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jun 2014 (11 years ago) |
| Document Number: | L14000101451 |
| FEI/EIN Number | 47-1330943 |
| Address: | 13241 BARTRAM PARK BLVD, # 413, JACKSONVILLE, FL, 32258, US |
| Mail Address: | 13241 BARTRAM PARK BLVD, # 413, JACKSONVILLE, FL, 32258, US |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760881163 | 2014-08-21 | 2014-11-12 | 13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL, 322585237, US | 13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL, 322585237, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-400-6800 |
| Fax | 9044006801 |
Authorized person
| Name | RAVI K KANCHA |
| Role | DOCTO |
| Phone | 9044006800 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | ME98044 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 277639100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Farah Law | Agent | 6550 St. Augustine Road, Jacksonville, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| KANCHA RAVI K | Auth | 13241 BARTRAM PARK BLVD, JACKSONVILLE, FL, 32258 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2018-03-06 | Farah Law | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-11 | 6550 St. Augustine Road, Suite 103, Jacksonville, FL 32217 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-05-02 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-03-05 |
| ANNUAL REPORT | 2015-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
