| Entity Name: | COMPREHENSIVE EAR NOSE THROAT ALLERGY SINUS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Oct 2014 (10 years ago) |
| Document Number: | L14000157846 |
| FEI/EIN Number | 47-2086409 |
| Address: | 1314 PINE STREET, MELBOURNE, FL, 32901, US |
| Mail Address: | 1314 PINE STREET, MELBOURNE, FL, 32901, US |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386005759 | 2016-03-14 | 2016-03-14 | 1314 PINE ST, MELBOURNE, FL, 329013117, US | 1314 PINE ST, MELBOURNE, FL, 329013117, US | |||||||||||||||||||||||||||||||
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| Phone | +1 321-802-6697 |
| Fax | 3218023158 |
Authorized person
| Name | DEAN R LINDSTROM III |
| Role | OWNER |
| Phone | 3218026697 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| License Number | ME111877 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004547400 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | FV242 |
| State | FL |
| Name | Role |
|---|---|
| 2010 SOLUTIONS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| LINDSTROM D RICHARD III | Managing Member | 826 LOGGERHEAD ISLAND DRIVE, SATELLITE BEACH, FL, 32937 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000092565 | DR LINDSTROM ENT | ACTIVE | 2024-08-03 | 2029-12-31 | No data | 1314 PINE STREET, MELBOURNE, FL, 32937 |
| G16000007758 | DR. LINDSTROM ENT | EXPIRED | 2016-01-21 | 2021-12-31 | No data | 1314 PINE STREET, MELBOURNE, FL, 32901 |
| G16000007759 | SINUS CARE CENTER OF BREVARD | EXPIRED | 2016-01-21 | 2021-12-31 | No data | 1314 PINE STREET, MELBOURNE, FL, 32901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-09 | 565 JACKSON AVE, UNIT C, SATELLITE BEACH, FL 32937 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-06 | 1314 PINE STREET, MELBOURNE, FL 32901 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-06 | 1314 PINE STREET, MELBOURNE, FL 32901 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-05-18 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-18 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-04-13 |
| ANNUAL REPORT | 2015-04-03 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1011187100 | 2020-04-09 | 0455 | PPP | 1314 Pine Street, Melbourne, FL, 32901-3117 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
