| Entity Name: | EMERALD COAST SPORTS MEDICINE AND ORTHOPAEDICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Nov 2002 (22 years ago) |
| Document Number: | P02000121217 |
| FEI/EIN Number | 651160592 |
| Address: | 339 RACETRACK RD., SUITE 12, FORT WALTON BEACH, FL, 32547 |
| Mail Address: | 339 RACETRACK RD., SUITE 12, FORT WALTON BEACH, FL, 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972583326 | 2006-01-20 | 2017-04-07 | 339 RACETRACK RD NW, SUITE 12, FORT WALTON BEACH, FL, 325471538, US | 339 RACETRACK RD NW, SUITE 12, FORT WALTON BEACH, FL, 325471538, US | |||||||||||||||
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| Phone | +1 850-864-3339 |
| Fax | 8508641715 |
Authorized person
| Name | LEO C CHEN |
| Role | PRESIDENT |
| Phone | 8508643339 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMERALD COAST SPORTS MEDICINE & ORT 401(K) PLAN | 2023 | 651160592 | 2024-06-11 | EMERALD COAST SPORTS MEDICINE AND ORTHOPAEDICS, P.A. | 9 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-11 |
| Name of individual signing | LEO CHEN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8509022244 |
| Plan sponsor’s address | 339 RACETRACK ROAD, SUITE #12, FORT WALTON BEACH, FL, 32547 |
Signature of
| Role | Plan administrator |
| Date | 2024-07-17 |
| Name of individual signing | LEO CHEN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8509022244 |
| Plan sponsor’s address | 339 RACETRACK ROAD, SUITE #12, FORT WALTON BEACH, FL, 32547 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-09 |
| Name of individual signing | LEO CHEN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MCINNIS C. JEFFREY | Agent | 909 MAR WALT DRIVE SUITE 1014, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| CHEN LEO C | President | 339 RACETRACK RD. STE 12, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2009-04-06 | 339 RACETRACK RD., SUITE 12, FORT WALTON BEACH, FL 32547 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-04 | 339 RACETRACK RD., SUITE 12, FORT WALTON BEACH, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-04-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
