| Entity Name: | COASTAL ANESTHESIA, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 May 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Oct 2015 (9 years ago) |
| Document Number: | P05000075726 |
| FEI/EIN Number | 202901443 |
| Address: | 1001 W. College Blvd., NICEVILLE, FL, 32578, US |
| Mail Address: | 111 BAYOU DRIVE, NICEVILLE, FL, 32578, US |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932205606 | 2006-09-16 | 2022-07-21 | PO BOX 10583, BIRMINGHAM, AL, 352020583, US | 1001 COLLEGE BLVD W STE H, NICEVILLE, FL, 325781049, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-867-8898 |
| Fax | 3527326282 |
| Phone | +1 850-279-4417 |
| Fax | 8502794212 |
Authorized person
| Name | DR. MICHAEL EDERER |
| Role | DO/PRESIDENT |
| Phone | 3528678898 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DE0932 |
| State | FL |
| Issuer | BCBS FL |
| Number | 98947 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Michelle K Ederer | Agent | 111 BAYOU DRIVE, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| EDERER MICHAEL | President | 111 BAYOU DRIVE, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| EDERER MICHELLE K | Vice President | 111 BAYOU DRIVE, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2015-10-14 | Michelle K Ederer | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-10-14 | 1001 W. College Blvd., Bldg. 2 STE # H, NICEVILLE, FL 32578 | No data |
| REINSTATEMENT | 2015-10-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-03 | 1001 W. College Blvd., Bldg. 2 STE # H, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-06-06 | 111 BAYOU DRIVE, NICEVILLE, FL 32578 | No data |
| REINSTATEMENT | 2011-06-06 | No data | No data |
| PENDING REINSTATEMENT | 2011-06-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2007-11-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-27 |
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-01-17 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-04 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-21 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-04-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
