| Entity Name: | EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Oct 2004 (20 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 09 Jan 2006 (19 years ago) |
| Document Number: | P04000137184 |
| FEI/EIN Number | 562483799 |
| Address: | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Mail Address: | 917 MAR WALT DRIVE, 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 | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720017882 | 2006-07-01 | 2008-04-25 | 917 MAR WALT DR, FORT WALTON BEACH, FL, 325476759, US | 917 MAR WALT DR, FORT WALTON BEACH, FL, 325476759, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 850-862-3979 |
Authorized person
| Name | SANDY ANASTASIO |
| Role | OFFICE MANAGER |
| Phone | 8508623979 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BAMBI MARQUARDT | Agent | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| SQUATRITO ERIC | President | 917 MAR WALT DRIVE SUTE, FORT WALTON BEACH, FL, 32547 |
| GEAR KELLEY | President | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| SQUATRITO ERIC | Secretary | 917 MAR WALT DRIVE SUTE, FORT WALTON BEACH, FL, 32547 |
| GEAR KELLEY | Secretary | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| MARQUARDT BAMBI | Secretary | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| SQUATRITO ERIC | Treasurer | 917 MAR WALT DRIVE SUTE, FORT WALTON BEACH, FL, 32547 |
| GEAR KELLEY | Treasurer | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| SQUATRITO ERIC | Director | 917 MAR WALT DRIVE SUTE, FORT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| GEAR KELLEY | Vice President | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000130724 | BAY FOOT AND ANKLE CENTER | ACTIVE | 2024-10-24 | 2029-12-31 | No data | 917 MAR WALT DR, FORT WALTON BEACH, FL, 32547 |
| G24000102383 | AMERICAN MEDICAL GROUP | ACTIVE | 2024-08-28 | 2029-12-31 | No data | 917 MAR WALT DR, FORT WALTON BEACH, FL, 32547 |
| G16000024110 | SYNERGY SPECIALTY PHARMACY | ACTIVE | 2016-03-07 | 2026-12-31 | No data | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-16 | BAMBI, MARQUARDT | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-09 | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 2007-01-09 | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-01-09 | 917 MAR WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| CANCEL ADM DISS/REV | 2006-01-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-17 |
| AMENDED ANNUAL REPORT | 2016-06-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
