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GASTROENTEROLOGY CARE SPECIALISTS, LLC - Florida Company Profile

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Company Details

Entity Name: GASTROENTEROLOGY CARE SPECIALISTS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 16 Sep 2019 (6 years ago)
Document Number: L19000233529
FEI/EIN Number 843099690
Address: 150 E Redstone Avenue, CRESTVIEW, FL, 32539, US
Mail Address: 150 E Redstone Avenue, CRESTVIEW, FL, 32539, US
ZIP code: 32539
City: Crestview
County: Okaloosa
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MOUSSA KHALID M Authorized Member 150 E Redstone Avenue, CRESTVIEW, FL, 32539
MOUSSA KHALID M Agent 150 E Redstone Avenue, CRESTVIEW, FL, 32539

Unique Entity ID

CAGE Code:
8JVP4
UEI Expiration Date:
2021-04-07

Business Information

Activation Date:
2020-04-21
Initial Registration Date:
2020-02-17

Commercial and government entity program

CAGE number:
8JVP4
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2025-04-22
CAGE Expiration:
2025-04-21
SAM Expiration:
2021-10-04

Contact Information

POC:
TERESA OBRY

National Provider Identifier

NPI Number:
1750922399
Certification Date:
2024-11-25

Authorized Person:

Name:
DR. KHALID MOUSSA
Role:
DR
Phone:

Taxonomy:

Selected Taxonomy:
207RG0100X - Gastroenterology Physician
Is Primary:
Yes

Contacts:

Fax:
8503988470

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-03-24 150 E Redstone Avenue, Suite B, CRESTVIEW, FL 32539 -
CHANGE OF MAILING ADDRESS 2022-03-24 150 E Redstone Avenue, Suite B, CRESTVIEW, FL 32539 -
REGISTERED AGENT ADDRESS CHANGED 2022-03-24 150 E Redstone Avenue, Suite B, CRESTVIEW, FL 32539 -

Documents

Name Date
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-03-24
ANNUAL REPORT 2021-04-28
ANNUAL REPORT 2020-04-27
Florida Limited Liability 2019-09-16

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Date of last update: 03 Aug 2025

Sources: Florida Department of State