| Entity Name: | VEIN ASSOCIATES, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Dec 2004 (20 years ago) |
| Date of dissolution: | 26 Sep 2008 (16 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2008 (16 years ago) |
| Document Number: | P04000170278 |
| FEI/EIN Number | 202030379 |
| Address: | 2909 BAY TO BAY BLVD., SUITE 305, TAMPA, FL, 33629 |
| Mail Address: | 400 INTERNATIONAL PKWY, SUITE 100, HEATHROW, FL, 32746 |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | VEIN ASSOCIATES, PA, MINNESOTA | 06048033-8bd4-e011-a886-001ec94ffe7f | MINNESOTA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326076902 | 2006-06-30 | 2008-07-22 | PO BOX 863550, ORLANDO, FL, 328863550, US | 400 INTERNATIONAL PKWY, SUITE 100, HEATHROW, FL, 327465061, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 803-808-8070 |
| Fax | 8038088074 |
Authorized person
| Name | DR. ROBERT JAMES THEOBALD III |
| Role | PHYSICIAN |
| Phone | 8038088070 |
Taxonomy
| Taxonomy Code | 202K00000X - Phlebology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS GROUP NUMBER |
| Number | 97985 |
| State | FL |
| Issuer | BCBS GROUP NUMBER |
| Number | 53M96RE |
| State | MN |
| Name | Role | Address |
|---|---|---|
| SCHENKER ANDREW | Agent | 400 INTERNATIONAL PKWY SUITE 100, HEATHROW, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| THEOBALD ROBERT D | President | 400 INTERNATIONAL PKWY SUITE 100, HEATROW, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| SCHENKER ANDREW | Chief Financial Officer | 400 INTERNATIONAL PKWY SUITE 100, HEATROW, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-10-25 | 2909 BAY TO BAY BLVD., SUITE 305, TAMPA, FL 33629 | No data |
| CHANGE OF MAILING ADDRESS | 2006-10-25 | 2909 BAY TO BAY BLVD., SUITE 305, TAMPA, FL 33629 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-10-25 | SCHENKER, ANDREW | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-10-25 | 400 INTERNATIONAL PKWY SUITE 100, HEATHROW, FL 32746 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2007-08-31 |
| ANNUAL REPORT | 2006-10-25 |
| Off/Dir Resignation | 2005-12-12 |
| Domestic Profit | 2004-12-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
