| Entity Name: | FIRST COAST PHYSICAL MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Nov 2005 (19 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P05000154791 |
| FEI/EIN Number | 542187997 |
| Address: | 13850 SW 100TH AVENUE, MIAMI, FL, 33176 |
| Mail Address: | 13850 SW 100TH AVENUE, MIAMI, FL, 33176 |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467550525 | 2006-09-20 | 2020-08-22 | P. O. BOX 55065, JACKSONVILLE, FL, 322162790, US | 3100 UNIVERSITY BLVD. S., SUITE 320, JACKSONVILLE, FL, 322162790, US | |||||||||||||||
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| Phone | +1 904-727-7733 |
| Fax | 9047277737 |
Authorized person
| Name | MS. JANET L. STEPHENS |
| Role | OFFICE MANAGER |
| Phone | 9047277733 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WALLACH RICHARD S | Agent | 13850 SW 100 AVENUE, MIAMI, FL, 33176 |
| Name | Role | Address |
|---|---|---|
| WALLACH RICHARD S | Director | 13850 SW 100 AVENUE, MIAMI, FL, 33176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-27 | 13850 SW 100TH AVENUE, MIAMI, FL 33176 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-27 | 13850 SW 100TH AVENUE, MIAMI, FL 33176 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-09-13 | WALLACH, RICHARD SPRES. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-09-13 | 13850 SW 100 AVENUE, MIAMI, FL 33176 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-04-27 |
| ANNUAL REPORT | 2008-04-08 |
| ANNUAL REPORT | 2007-01-05 |
| ANNUAL REPORT | 2006-09-13 |
| ANNUAL REPORT | 2006-04-20 |
| Domestic Profit | 2005-11-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
