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  5. COASTAL CARDIOLOGY, P.A.

COASTAL CARDIOLOGY, P.A.

Company Details

Entity Name: COASTAL CARDIOLOGY, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 16 Jun 2005 (20 years ago)
Date of dissolution: 28 Sep 2012 (12 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2012 (12 years ago)
Document Number: P05000086946
FEI/EIN Number 203011763
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

National Provider Identifier

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

Contacts
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

form 5500

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
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 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
COASTAL CARDIOLOGY, P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2010 203011763 2011-02-28 COASTAL CARDIOLOGY, P.A. 27
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
COASTAL CARDIOLOGY, P.A. 401K PROFIT SHARING PLAN AND TRUST 2009 203011763 2010-07-09 COASTAL CARDIOLOGY, P.A. 26
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

Agent

Name Role Address
KYLE KEVIN A Agent 1380 ROYAL PALM SQUARE BLVD., FORT MYERS, FL, 33919

Director

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

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2012-09-28 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-04-01 16261 BASS ROAD, #300, FORT MYERS, FL 33908 No data
CHANGE OF MAILING ADDRESS 2009-04-01 16261 BASS ROAD, #300, FORT MYERS, FL 33908 No data
REGISTERED AGENT NAME CHANGED 2009-04-01 KYLE, KEVIN A No data
REGISTERED AGENT ADDRESS CHANGED 2009-04-01 1380 ROYAL PALM SQUARE BLVD., FORT MYERS, FL 33919 No data

Documents

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

Related by officers

LEE STEVEN T

REUNION MAGIC, LLC CYBERVILLE, LLC BKC RENTALS, LLC EASTSIDE PLAZA, LLC OCALA DASH, LLC OCALA EXTRAS, LLC BREECH PROPERTIES, LLC NEXT 2 LLC BREAKFAST CLUB, LLC PAT AND MARION'S, LLC

GROHOWSKI ROBERT M

CAPE CORGI ENTERPRISES, LLC

KYLE KEVIN A

INSURANCE FIRE & WATER RESTORATIONS, LLC REUNION MAGIC, LLC C.Y.L. ENTERPRISE PROPERTIES, LLC METRO 38, LLC ASSOCIATION FOR MAINTENANCE PROFESSIONALS, INC. W. STANLEY HANSON FOUNDATION FOR NATIVE AMERICAN STUDIES, INC. RIGSBY INVESTMENT GROUP, LLC RJMT, LLC VIKING REAL ESTATE MANAGEMENT, LLC MOTORSPORTS OF ASHEVILLE, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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