| Entity Name: | SOUTHEAST ORTHOTICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Jan 2002 (23 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 26 Oct 2005 (19 years ago) |
| Document Number: | P02000000507 |
| FEI/EIN Number | 721522005 |
| Address: | 10506 Cory Lake Drive, TAMPA, FL, 33647, US |
| Mail Address: | 10506 CORY LAKE DRIVE, TAMPA, FL, 33647, US |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033130182 | 2006-07-22 | 2011-07-05 | 10506 CORY LAKE DR, TAMPA, FL, 336472710, US | 17429 BRIDGE HILL CT, SUITE D, TAMPA, FL, 336473467, US | |||||||||||||||||||||||||
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| Phone | +1 813-986-9657 |
| Fax | 8139821034 |
| Phone | +1 813-615-2277 |
| Fax | 8136323377 |
Authorized person
| Name | BRENT E SQUIRES |
| Role | OWNER |
| Phone | 8139869657 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | M2602 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SQUIRES BRENT E | Agent | 10506 CORY LAKE DRIVE, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| SQUIRES BRENT E | President | 10506 CORY LAKE DRIVE, TAMPA, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-15 | 10506 Cory Lake Drive, TAMPA, FL 33647 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-12 | 10506 Cory Lake Drive, TAMPA, FL 33647 | No data |
| CANCEL ADM DISS/REV | 2005-10-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-07-06 | 10506 CORY LAKE DRIVE, TAMPA, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-10 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-04-22 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
