| Entity Name: | EMERALD ENT, ALLERGY, HEARING AND FACIAL PLASTICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jul 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Aug 2021 (4 years ago) |
| Document Number: | L21000336273 |
| FEI/EIN Number | 87-1894277 |
| Address: | 141 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459, US |
| Mail Address: | 141 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459, US |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003584475 | 2021-09-01 | 2022-07-27 | 141 MACK BAYOU LOOP STE 102, SANTA ROSA BEACH, FL, 324597194, US | 141 MACK BAYOU LOOP STE 102, SANTA ROSA BEACH, FL, 324597194, US | |||||||||||||||||||||||||
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| Phone | +1 850-797-6191 |
| Fax | 8507976191 |
| Fax | 8504208342 |
Authorized person
| Name | DR. RYAN EDGAR GEGG |
| Role | OWNER/PHYSICIAN |
| Phone | 8106103313 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| Is Primary | No |
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| Is Primary | No |
| Taxonomy Code | 207YX0905X - Otolaryngology/Facial Plastic Surgery Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GEGG RYAN | Agent | 141 MACK BAYOU LOOP, SANTA ROSA BEACH, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| GEGG RYAN | Manager | 141 MACK BAYOU LOOP, SANTA ROSA BEACH, FL, 32459 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000115482 | EMERALD ENT ALLERGY, HEARING & FACIAL PLASTICS, LLC | ACTIVE | 2021-09-08 | 2026-12-31 | No data | 141 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-08-05 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-08-05 | 141 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL 32459 | No data |
| CHANGE OF MAILING ADDRESS | 2021-08-05 | 141 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL 32459 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-02-11 |
| ANNUAL REPORT | 2022-03-16 |
| LC Amendment | 2021-08-05 |
| Florida Limited Liability | 2021-07-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
