| Entity Name: | COASTAL TIDES SURGICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 Apr 2024 (10 months ago) |
| Document Number: | L24000157694 |
| FEI/EIN Number | 99-2715744 |
| Address: | 1002 N Arnold Road, Suite 401, Panama City Beach, FL 32413 |
| Mail Address: | 1002 N Arnold Road, Suite 401, Panama City Beach, FL 32413 |
| ZIP code: | 32413 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609616291 | 2024-05-30 | 2024-05-30 | 1002 N ARNOLD ROAD, SUITE 401, PANAMA CITY BEACH, FL, 32413, US | 1002 N ARNOLD ROAD, SUITE 401, PANAMA CITY BEACH, FL, 32413, US | |||||||||||||
|
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| Phone | +1 850-509-7567 |
Authorized person
| Name | DANIEL DAVID STANNARD |
| Role | ADMINISTRATOR |
| Phone | 8505097567 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRYANT, GERALD | Agent | 215 SOUTH MONROE STREET, SUITE 200, TALLAHASSEE, FL 32301 |
| Name | Role |
|---|---|
| TALLAHASSEE MEMORIAL HEALTH VENTURES, INC. | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-04 | 1002 N Arnold Road, Suite 401, Panama City Beach, FL 32413 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-04 | 1002 N Arnold Road, Suite 401, Panama City Beach, FL 32413 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-04-02 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
