| Entity Name: | COASTAL CARDIOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
COASTAL CARDIOLOGY, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 16 Jun 2005 (20 years ago) |
| Date of dissolution: | 28 Sep 2012 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (13 years ago) |
| Document Number: | P05000086946 |
| FEI/EIN Number |
203011763
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 16261 BASS ROAD, #300, FORT MYERS, FL, 33908, US |
| Mail Address: | 16261 BASS ROAD, #300, FORT MYERS, FL, 33908, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174588255 | 2006-04-20 | 2010-05-24 | PO BOX 24853, MIAMI, FL, 331024853, US | 16261 BASS RD, SUITE 300, FORT MYERS, FL, 339083671, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 239-274-8866 |
| Fax | 2392748867 |
Authorized person
| Name | DR. JAMES A. CONRAD |
| Role | STAFF PHYSICIAN |
| Phone | 2392748866 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 273264500 |
| State | FL |
| Issuer | BCBS |
| Number | 74608 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DD8590 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COASTAL CARDIOLOGY, P.A. 401(K) PROFIT SHARING PLAN & TRUST | 2011 | 203011763 | 2012-03-08 | COASTAL CARDIOLOGY, P.A. | 24 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 203011763 |
| Plan administrator’s name | COASTAL CARDIOLOGY, P.A. |
| Plan administrator’s address | 16261 BASS ROAD, SUITE 300, FORT MYERS, FL, 33908 |
| Administrator’s telephone number | 2392748866 |
Signature of
| Role | Plan administrator |
| Date | 2012-03-08 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-03-08 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2007-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2392748866 |
| Plan sponsor’s address | 16261 BASS ROAD, SUITE 300, FORT MYERS, FL, 33908 |
Plan administrator’s name and address
| Administrator’s EIN | 203011763 |
| Plan administrator’s name | COASTAL CARDIOLOGY, P.A. |
| Plan administrator’s address | 16261 BASS ROAD, SUITE 300, FORT MYERS, FL, 33908 |
| Administrator’s telephone number | 2392748866 |
Signature of
| Role | Plan administrator |
| Date | 2011-02-28 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-02-28 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2007-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2392748866 |
| Plan sponsor’s address | 16261 BASS ROAD, SUITE 300, FORT MYERS, FL, 33908 |
Plan administrator’s name and address
| Administrator’s EIN | 203011763 |
| Plan administrator’s name | COASTAL CARDIOLOGY, P.A. |
| Plan administrator’s address | 16261 BASS ROAD, SUITE 300, FORT MYERS, FL, 33908 |
| Administrator’s telephone number | 2392748866 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-09 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-07-09 |
| Name of individual signing | STEVEN T. LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| LEE STEVEN T | Director | 16261 BASS RD SUITE 300., FORT MYERS, FL, 33908 |
| GROHOWSKI ROBERT M | Director | 16261 BASS RD SUITE 300, FORT MYERS, FL, 33908 |
| CONRAD JAMES A | Director | 16261 BASS RD SUITE 300, FORT MYERS, FL, 33908 |
| TASCHNER BRIAN C | Director | 16261 BASS RD SUITE 300, FORT MYERS, FL, 33908 |
| KYLE KEVIN A | Agent | 1380 ROYAL PALM SQUARE BLVD., FORT MYERS, FL, 33919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-01 | 16261 BASS ROAD, #300, FORT MYERS, FL 33908 | - |
| CHANGE OF MAILING ADDRESS | 2009-04-01 | 16261 BASS ROAD, #300, FORT MYERS, FL 33908 | - |
| REGISTERED AGENT NAME CHANGED | 2009-04-01 | KYLE, KEVIN A | - |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-01 | 1380 ROYAL PALM SQUARE BLVD., FORT MYERS, FL 33919 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-15 |
| ANNUAL REPORT | 2010-06-02 |
| ANNUAL REPORT | 2009-04-01 |
| ANNUAL REPORT | 2008-01-11 |
| ANNUAL REPORT | 2007-01-10 |
| ANNUAL REPORT | 2006-01-05 |
| Domestic Profit | 2005-06-16 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
