| Entity Name: | GULF COAST PMRA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Feb 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 14 Sep 2022 (2 years ago) |
| Document Number: | L21000063063 |
| FEI/EIN Number | 86-2101007 |
| Address: | 9369 GOLDEN RAIN LANE, FT MYERS, FL, 33967, UN |
| Mail Address: | 9369 GOLDEN RAIN LANE, FT MYERS, FL, 33967, UN |
| ZIP code: | 33967 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013502285 | 2021-03-09 | 2024-04-03 | PO BOX 61925, FORT MYERS, FL, 339061925, US | 9369 GOLDEN RAIN LN, FORT MYERS, FL, 339675136, US | |||||||||||||||||||||
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| Phone | +1 727-900-1326 |
| Fax | 7279546546 |
Authorized person
| Name | MR. RONALD DEAN DAYTON |
| Role | BILLING MNAGER |
| Phone | 7279001326 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 64098 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALHOUN VIOLETA | Agent | 9369 GOLDEN RAIN LANE, FT MYERS, FL, 33967 |
| Name | Role | Address |
|---|---|---|
| CALHOUN VIOLETA | Manager | 9369 GOLDEN RAIN LANE, FT MYERS, FL, 33967 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2022-09-14 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-09-14 | CALHOUN, VIOLETA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-14 | 9369 GOLDEN RAIN LANE, FT MYERS, FL 33967 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-07 | 9369 GOLDEN RAIN LANE, FT MYERS, FL 33967 UN | No data |
| CHANGE OF MAILING ADDRESS | 2022-09-07 | 9369 GOLDEN RAIN LANE, FT MYERS, FL 33967 UN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-04 |
| ANNUAL REPORT | 2024-01-06 |
| ANNUAL REPORT | 2023-01-13 |
| LC Amendment | 2022-09-14 |
| ANNUAL REPORT | 2022-01-06 |
| Florida Limited Liability | 2021-02-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
