| Entity Name: | VEIN TREATMENT CENTER OF PALM COAST, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Jan 2005 (20 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | P05000010887 |
| FEI/EIN Number | 562497596 |
| Mail Address: | P.O. BOX 730657, ORMOND BEACH, FL, 32173, US |
| Address: | 598 Sterthaus Dr, Ormond Beach, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689893224 | 2007-04-24 | 2013-02-11 | PO BOX 279, FLAGLER BEACH, FL, 321360279, US | 21 HOSPITAL DR, SUITE 260, PALM COAST, FL, 321642452, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-586-5344 |
| Fax | 3865865450 |
Authorized person
| Name | DR. NICKOLAS JOHN COLLUCCI |
| Role | PRESIDENT |
| Phone | 3865865344 |
Taxonomy
| Taxonomy Code | 202K00000X - Phlebology Physician |
| License Number | ME39243 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 202K00000X - Phlebology Physician |
| License Number | OS4153 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS4153 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207VH0002X - Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician |
| License Number | ME39243 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| STEIN CHARLES IMD | Agent | 598 Sterthaus Dr, Ormond Beach, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| STEIN CHARLES IDR. | President | P.O. BOX 730657, ORMOND BEACH, FL, 32173 |
| Name | Role | Address |
|---|---|---|
| Stein Suzanne | Director | P.O. BOX 730657, ORMOND BEACH, FL, 32173 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-08 | 598 Sterthaus Dr, Ormond Beach, FL 32174 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-08 | 598 Sterthaus Dr, Ormond Beach, FL 32174 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-04-05 | STEIN, CHARLES IRA, MD | No data |
| CHANGE OF MAILING ADDRESS | 2007-02-19 | 598 Sterthaus Dr, Ormond Beach, FL 32174 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-02-10 |
| ANNUAL REPORT | 2014-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
