| Entity Name: | EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Mar 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Jun 2012 (13 years ago) |
| Document Number: | P05000039234 |
| FEI/EIN Number | 202535830 |
| Address: | 1032 MAR WALT DR, SUITE 100, FT WALTON BEACH, FL, 32547 |
| Mail Address: | 1032 MAR WALT DR, SUITE 100, FT WALTON BEACH, FL, 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265477574 | 2006-06-19 | 2020-08-22 | 1032 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL, 325476645, US | 1032 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL, 325476645, US | |||||||||||||||||||
|
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| Phone | +1 850-796-1368 |
| Fax | 8507962368 |
Authorized person
| Name | DR. JOSEPH DANIEL SIEFKER |
| Role | DOCTOR |
| Phone | 8507961368 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| License Number | ME93776 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Siefker Joseph DDr. | Agent | 909 MAR WALT DR SUITE 1014, FT WALTON BEACH, FL, 32547 |
| Name | Role | Address |
|---|---|---|
| SIEFKER JOSEPH D | Director | 1032 MAR WALT DR SUITE 100, FORT WALTON BEACH, FL, 32547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-08-03 | Siefker, Joseph D, Dr. | No data |
| REINSTATEMENT | 2012-06-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-27 | 1032 MAR WALT DR, SUITE 100, FT WALTON BEACH, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 2006-01-27 | 1032 MAR WALT DR, SUITE 100, FT WALTON BEACH, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-08-03 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-01-03 |
| ANNUAL REPORT | 2018-01-03 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-01-04 |
| ANNUAL REPORT | 2015-01-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
