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EMERALD COAST PEDIATRIC PRIMARY CARE, INC.

EMERALD COAST PEDIATRIC PRIMARY CARE, INC.

Company Details

Entity Name:	EMERALD COAST PEDIATRIC PRIMARY CARE, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Non-Profit
Status:	Inactive
Date Filed:	17 Aug 1992 (32 years ago)
Document Number:	N50394
FEI/EIN Number	593141073
Address:	5192 BAYOU BLVD., PENSACOLA, FL, 32504, US
Mail Address:	5192 BAYOU BLVD., PENSACOLA, FL, 32504, US
ZIP code:	32504
County:	Escambia
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1912979519

2006-02-07

2020-08-22

5192 BAYOU BLVD, PENSACOLA, FL, 325032102, US

5192 BAYOU BLVD, PENSACOLA, FL, 325032102, US

Contacts

Phone	+1 850-484-5040
Fax	8504755527

Authorized person

Name	MRS. CATHLEEN M. FARROLL
Role	ADMINISTRATOR
Phone	8504845040

Taxonomy

Taxonomy Code	261QP2300X - Primary Care Clinic/Center
Is Primary	Yes

Agent

Name	Role	Address
FARROLL CATHLEEN	Agent	5192 BAYOU BLVD., PENSACOLA, FL, 32504

President

Name	Role	Address
WOLFE COREY	President	1530 AIRPORT BLVD, PENSACOLA, FL, 32514

Director

Name	Role	Address
WHITTAKER JOAN	Director	2299 SCENIC HWY -2, PENSACOLA, FL, 32503
WILSON ROBERT K	Director	5192 BAYOU BLVD, PENSACOLA, FL, 32504
SIMS STEVE	Director	232 NORTHCLIFF DR, GULF BREEZE, FL, 32561
DELGADO AUDREY	Director	1289 E.AVERY, PENSACOLA, FL, 32503

SCT

Name	Role	Address
FARROLL CATHLEEN	SCT	5192 BAYOU BLVD., PENSACOLA, FL, 32503

Events

Event Type	Filed Date	Value	Description
ADMIN DISSOLUTION FOR ANNUAL REPORT	2011-09-23	No data	No data
CANCEL ADM DISS/REV	2004-04-06	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	2002-10-04	No data	No data

Date of last update: 02 Jan 2025

Sources: Florida Department of State