| Entity Name: | DR. VIVIAN EBERT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Feb 2000 (25 years ago) |
| Document Number: | P00000012997 |
| FEI/EIN Number | 651010592 |
| Mail Address: | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL, 34119, US |
| Address: | 10020 COCONUT ROAD, STE 134, BONITA SPRINGS, FL, 34135, US |
| ZIP code: | 34135 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447373394 | 2007-04-07 | 2011-01-20 | 10020 COCONUT RD., #134, BONITA SPRINGS, FL, 341358136, US | 10020 COCONUT RD., #134, BONITA SPRINGS, FL, 341358136, US | |||||||||||||||||||||||||
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| Phone | +1 239-498-2225 |
| Fax | 2394980347 |
Authorized person
| Name | DR. VIVIAN D EBERT |
| Role | OWNER |
| Phone | 2394982225 |
Taxonomy
| Taxonomy Code | 111NS0005X - Sports Physician Chiropractor |
| License Number | CH0003942 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 380574300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EBERT VIVIAN | Agent | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| EBERT VIVIAN | President | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| EBERT VIVIAN | Treasurer | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| EBERT VIVIAN | Director | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL, 34119 |
| Name | Role | Address |
|---|---|---|
| Ebert Jon F | Secretary | 5270 Tamarind ridge drive, Naples, FL, 34119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-28 | 10020 COCONUT ROAD, STE 134, BONITA SPRINGS, FL 34135 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-28 | 10020 COCONUT ROAD, STE 134, BONITA SPRINGS, FL 34135 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-04-28 | EBERT, VIVIAN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-28 | 5270 TAMARIND RIDGE DRIVE, NAPLES, FL 34119 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-04-20 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
