| Entity Name: | COASTAL HEALTH PRIMARY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Oct 2022 (2 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 13 Dec 2023 (a year ago) |
| Document Number: | L22000440215 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 705 WELLS ROAD, Suite 300, ORANGE PARK, FL 32073 |
| Mail Address: | 705 WELLS ROAD, Suite 300, ORANGE PARK, FL 32073 |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023734340 | 2022-10-18 | 2024-04-26 | 705 WELLS RD STE 300, ORANGE PARK, FL, 320732982, US | 705 WELLS RD STE 300, ORANGE PARK, FL, 320732982, US | |||||||||||||||
|
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| Phone | +1 904-282-6331 |
| Fax | 9046191080 |
Authorized person
| Name | ANDREW T CHRISTMAN |
| Role | CEO |
| Phone | 9416857688 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| MH CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Powell, Kenneth | Manager | 705 WELLS ROAD, Suite 300 ORANGE PARK, FL 32073 |
| PHYSICIANS GROUP SERVICES, PA | Manager | 705 WELLS ROAD, Suite 300 ORANGE PARK, FL 32073 |
| Name | Role | Address |
|---|---|---|
| Christman, Andrew | Chief Executive Officer | 705 WELLS ROAD, Suite 300 ORANGE PARK, FL 32073 |
| Name | Role | Address |
|---|---|---|
| Taboh, Gregg | Chief Operating Officer | 705 WELLS ROAD, Suite 300 ORANGE PARK, FL 32073 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000056952 | COASTAL HEALTH PRIMARY CARE | ACTIVE | 2023-05-04 | 2028-12-31 | No data | 705 WELLS ROAD, SUITE 300, ORANGE PARK, FL, 32072 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2023-12-13 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-24 | 705 WELLS ROAD, Suite 300, ORANGE PARK, FL 32073 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-24 | 705 WELLS ROAD, Suite 300, ORANGE PARK, FL 32073 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-24 | MH Corporate Services, Inc. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-24 | 14 East Bay Street, JACKSONVILLE, FL 32202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| LC Amendment | 2023-12-13 |
| ANNUAL REPORT | 2023-04-24 |
| Florida Limited Liability | 2022-10-12 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
