| Entity Name: | RIVERSIDE MEDICAL CENTER, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Aug 2003 (21 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 15 Apr 2005 (20 years ago) |
| Document Number: | P03000092656 |
| FEI/EIN Number | 562389983 |
| Address: | 863 N. COCOA BLVD., COCOA, FL, 32922, US |
| Mail Address: | 863 N. COCOA BLVD., COCOA, FL, 32922, US |
| ZIP code: | 32922 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093884439 | 2006-11-07 | 2017-08-03 | 3206 S HOPKINS AVE, SUITE 87, TITUSVILLE, FL, 327805667, US | 863 N COCOA BLVD, COCOA, FL, 329227510, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-264-2345 |
| Fax | 3217358882 |
Authorized person
| Name | DR. JANET E MILEY |
| Role | MEDICAL DIRECTOR |
| Phone | 3212642345 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 207RC0200X |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS INSURANCE |
| Number | 03280 |
| State | FL |
| Issuer | CIGNA INSURANCE |
| Number | 7883229001 |
| State | FL |
| Issuer | AETNA INSURANCE |
| Number | 7276274 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MILEY JANET E | Agent | 863 North Cocoa Blvd, Cocoa, FL, 32922 |
| Name | Role | Address |
|---|---|---|
| MILEY JANET E | Manager | 863 North Cocoa Blvd, Cocoa, FL, 32922 |
| Name | Role | Address |
|---|---|---|
| MILEY JANET E | Director | 863 North Cocoa Blvd, Cocoa, FL, 32922 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-28 | 863 North Cocoa Blvd, Cocoa, FL 32922 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-12-19 | 863 N. COCOA BLVD., COCOA, FL 32922 | No data |
| CHANGE OF MAILING ADDRESS | 2016-12-19 | 863 N. COCOA BLVD., COCOA, FL 32922 | No data |
| CANCEL ADM DISS/REV | 2005-04-15 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-15 | MILEY, JANET EMD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-04-13 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
