| Entity Name: | COASTAL INJURY CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Jul 2020 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 13 Dec 2023 (a year ago) |
| Document Number: | M20000006404 |
| FEI/EIN Number | 851849563 |
| Address: | 705 Wells Road, Suite 300, Orange Park, FL, 32073, US |
| Mail Address: | 705 Wells Road, Suite 300, Orange Park, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437768033 | 2020-07-29 | 2024-04-26 | PO BOX 1869, ORANGE PARK, FL, 320671869, US | 2700 RIVERSIDE AVE STE 1, JACKSONVILLE, FL, 322058233, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 904-559-6638 |
| Fax | 8889270401 |
Authorized person
| Name | ANDREW T CHRISTMAN |
| Role | CEO |
| Phone | 9416857688 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | No |
| Name | Role |
|---|---|
| MH CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| POWELL KENNETH | 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 |
| Name | Role |
|---|---|
| PHYSICIANS GROUP SERVICES, P.A. | Auth |
| 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 | 2021-03-18 | 14 East Bay Street, Jacksonville, FL 32202 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| LC Amendment | 2023-12-13 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-28 |
| AMENDED ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2021-03-02 |
| Foreign Limited | 2020-07-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
