| Entity Name: | EMERALD COAST SLEEP DIAGNOSTICS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Apr 2020 (5 years ago) |
| Branch of: | EMERALD COAST SLEEP DIAGNOSTICS LLC, ALABAMA (Company Number 000-627-747) |
| Document Number: | M20000003830 |
| FEI/EIN Number | 84-5123419 |
| Address: | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 |
| Mail Address: | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 |
| ZIP code: | 32401 |
| County: | Bay |
| Place of Formation: | ALABAMA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912529116 | 2020-05-11 | 2022-10-26 | 620 MCKENZIE AVE, PANAMA CITY, FL, 324013062, US | 620 MCKENZIE AVE, PANAMA CITY, FL, 324013062, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-518-7378 |
| Fax | 8506404187 |
Authorized person
| Name | AMBER MCKENZIE |
| Role | AUTHORIZED OFFICIAL |
| Phone | 8508669990 |
Taxonomy
| Taxonomy Code | 207YS0012X - Sleep Medicine (Otolaryngology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106159700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, AMBER | Agent | 2103 Andrews Rd, LYNN HAVEN, FL 32444 |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, AMBER | Manager | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, AMBER | Member | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 |
| MCLEOD, F. ANTHONY | Member | 3368 HWY 280 STE G-15, ALEXNDER CITY, AL 35010 |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, AMBER | Authorized Person | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-28 | 2103 Andrews Rd, LYNN HAVEN, FL 32444 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-20 | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-20 | 620 MCKENZIE AVE, PANAMA CITY, FL 32401 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-20 | MCKENZIE, AMBER | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-06-23 |
| Foreign Limited | 2020-04-20 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
