| Entity Name: | TREASURE COAST COSMETIC SURGERY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 04 Aug 1988 (37 years ago) |
| Date of dissolution: | 14 Sep 2007 (17 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 14 Sep 2007 (17 years ago) |
| Document Number: | M92924 |
| FEI/EIN Number | 65-0061011 |
| Address: | 1901 S.E. PORT ST. LUCE BLVD., PORT ST. LUCIE, FL 34952 |
| Mail Address: | 1901 S.E. PORT ST. LUCE BLVD., PORT ST. LUCIE, FL 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952327538 | 2006-07-15 | 2020-08-22 | 1901 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL, 349525582, US | 1901 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL, 349525582, US | |||||||||||||||||||||||||||||||
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| Phone | +1 772-335-7477 |
| Fax | 7723358379 |
Authorized person
| Name | DR. DONATO ANTHONY VIGGIANO |
| Role | MEDICAL DIRECTOR |
| Phone | 7723357477 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 741 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 667 |
| State | FL |
| Issuer | WORKERS COMP |
| Number | AS0000349 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCCLINTOCK, JOYCE E | Agent | 1703 SE ADAIR RD, PORT ST. LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| VIGGIANO, DONATO A | Director | 1901 S.E. PT. ST. LUCIE BLVD., PT. ST. LUCIE, FL 34952 |
| MCCLINTOCK, JOYCE E | Director | 1901 S.E. PT. ST. LUCIE BLVD., PT. ST. LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| VIGGIANO, DONATO A | President | 1901 S.E. PT. ST. LUCIE BLVD., PT. ST. LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| MCCLINTOCK, JOYCE E | Secretary | 1901 S.E. PT. ST. LUCIE BLVD., PT. ST. LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| MCCLINTOCK, JOYCE E | Treasurer | 1901 S.E. PT. ST. LUCIE BLVD., PT. ST. LUCIE, FL 34952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-03-08 | 1703 SE ADAIR RD, PORT ST. LUCIE, FL 34952 | No data |
| REINSTATEMENT | 2004-03-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-09-06 | 1901 S.E. PORT ST. LUCE BLVD., PORT ST. LUCIE, FL 34952 | No data |
| CHANGE OF MAILING ADDRESS | 2001-09-06 | 1901 S.E. PORT ST. LUCE BLVD., PORT ST. LUCIE, FL 34952 | No data |
| REGISTERED AGENT NAME CHANGED | 2001-09-06 | MCCLINTOCK, JOYCE E | No data |
| REINSTATEMENT | 2000-12-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-07-03 |
| ANNUAL REPORT | 2005-03-23 |
| REINSTATEMENT | 2004-03-08 |
| ANNUAL REPORT | 2002-04-08 |
| ANNUAL REPORT | 2001-09-06 |
| REINSTATEMENT | 2000-12-08 |
| ANNUAL REPORT | 1999-04-13 |
| ANNUAL REPORT | 1998-04-22 |
| ANNUAL REPORT | 1997-04-21 |
| ANNUAL REPORT | 1996-04-19 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
