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COASTAL INTERNAL MEDICINE SPECIALISTS, P.A. - Florida Company Profile

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Company Details

Entity Name: COASTAL INTERNAL MEDICINE SPECIALISTS, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 13 Sep 2000 (25 years ago)
Date of dissolution: 27 Sep 2019 (6 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2019 (6 years ago)
Document Number: P00000086846
FEI/EIN Number 651039449
Address: 5172 Mason Corbin Court, FORT MYERS, FL, 33907, US
Mail Address: 5172 Mason Corbin Court, FORT MYERS, FL, 33907, US
ZIP code: 33907
City: Fort Myers
County: Lee
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
JACOBS ALLEN T Secretary 2864 Triggerfish street, Matlacha, FL, 33993
JACOBS ALLEN T Treasurer 2864 Triggerfish street, Matlacha, FL, 33993
JACOBS ALLEN T Director 2864 Triggerfish street, Matlacha, FL, 33993
HEMED IRIT Vice President 13817 Pine Villa Lane, FORT MYERS, FL, 33912
HEMED IRIT Director 13817 Pine Villa Lane, FORT MYERS, FL, 33912
MARTIN BRIAN G Manager 6689 HIGHLAND PINES CIRCLE, FORT MYERS, FL, 33912
MARTIN BRIAN G Director 6689 HIGHLAND PINES CIRCLE, FORT MYERS, FL, 33912
JACOBS ALLEN Agent 2864 Triggerfish Street, Matlacha, FL, 33993

National Provider Identifier

NPI Number:
1215914072

Authorized Person:

Name:
MR. BRIAN G. MARTIN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2399367455

Form 5500 Series

Employer Identification Number (EIN):
651039449
Plan Year:
2018
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
12
Sponsors Telephone Number:

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 - -
REINSTATEMENT 2015-12-22 - -
CHANGE OF PRINCIPAL ADDRESS 2015-12-22 5172 Mason Corbin Court, Suite 1, FORT MYERS, FL 33907 -
REGISTERED AGENT ADDRESS CHANGED 2015-12-22 2864 Triggerfish Street, Matlacha, FL 33993 -
CHANGE OF MAILING ADDRESS 2015-12-22 5172 Mason Corbin Court, Suite 1, FORT MYERS, FL 33907 -
REGISTERED AGENT NAME CHANGED 2015-12-22 JACOBS, ALLEN -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 - -

Documents

Name Date
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-03-28
REINSTATEMENT 2015-12-22
ANNUAL REPORT 2014-01-22
ANNUAL REPORT 2013-02-06
ANNUAL REPORT 2012-02-22
ANNUAL REPORT 2012-01-10
ANNUAL REPORT 2011-02-17
ANNUAL REPORT 2010-01-11

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Date of last update: 02 Aug 2025

Sources: Florida Department of State