| Entity Name: | PALM BAY ANESTHESIA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Aug 2003 (21 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P03000094815 |
| FEI/EIN Number | 810629991 |
| Address: | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Mail Address: | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| ZIP code: | 32907 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780617738 | 2006-07-09 | 2020-08-22 | PO BOX 320129, MELBOURNE, FL, 32932, US | 1051 HICKORY ST, MELBOURNE, FL, 329011962, US | |||||||||||||||
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| Phone | +1 321-784-3700 |
| Fax | 3217844090 |
Authorized person
| Name | MARK VANDENBOSCH |
| Role | OWNER |
| Phone | 3217843700 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| COLEMAN CHRISTOPHER J | Agent | 1329 BEDFORD DRIVE, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| VANDENBOSCH MARK J | Director | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| HARPER STEVEN | Director | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| MURTHA PATRICK A | Director | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| BLACKWOOD ROBERT S | Director | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Name | Role | Address |
|---|---|---|
| VANDENBOSCH MARK J | President | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Name | Role | Address |
|---|---|---|
| HARPER STEVEN | Vice President | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Name | Role | Address |
|---|---|---|
| MURTHA PATRICK A | Secretary | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Name | Role | Address |
|---|---|---|
| BLACKWOOD ROBERT S | Treasurer | 1425 MALABAR ROAD N.E., PALM BAY, FL, 32907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-04-04 |
| ANNUAL REPORT | 2010-02-26 |
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-01-09 |
| ANNUAL REPORT | 2007-02-08 |
| ANNUAL REPORT | 2006-04-04 |
| ANNUAL REPORT | 2005-07-01 |
| ANNUAL REPORT | 2004-04-06 |
| Domestic Profit | 2003-08-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
