| Entity Name: | COASTAL VEIN & VASCULAR INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jul 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 16 Oct 2018 (6 years ago) |
| Document Number: | L15000122409 |
| FEI/EIN Number | 47-4650347 |
| Address: | 3599 UNIVERSITY BLVD. SOUTH, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 3599 UNIVERSITY BLVD. SOUTH, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689052359 | 2015-05-13 | 2016-02-16 | 3599 UNIVERSITY BLVD S, BLDG 300, JACKSONVILLE, FL, 322164252, US | 7741 POINT MEADOWS DR, UNIT 104-106, JACKSONVILLE, FL, 322569182, US | |||||||||||||||||||
|
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| Phone | +1 904-399-5550 |
| Fax | 9043464334 |
Authorized person
| Name | KURT W MORI |
| Role | PRESIDENT |
| Phone | 9043995550 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Kottler Nina MD | Auth | 2330 Utah Ave, El Segundo, CA, 90245 |
| Name | Role |
|---|---|
| MORI, BEAN AND BROOKS, INC. | Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-22 | 3599 UNIVERSITY BLVD. SOUTH, Suite 300, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-22 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-22 | 3599 UNIVERSITY BLVD. SOUTH, Suite 300, JACKSONVILLE, FL 32216 | No data |
| LC AMENDMENT | 2018-10-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-16 | CORPORATION SERVICE COMPANY | No data |
| REINSTATEMENT | 2017-03-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2015-11-09 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-01-08 |
| LC Amendment | 2018-10-16 |
| ANNUAL REPORT | 2018-03-30 |
| REINSTATEMENT | 2017-03-30 |
| LC Amendment | 2015-11-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
