| Entity Name: | CARDIOVASCULAR HEALTH CONSULTANTS, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 17 May 2006 (19 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Dec 2022 (2 years ago) |
| Document Number: | P06000069655 |
| FEI/EIN Number | 20-4869058 |
| Address: | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 |
| Mail Address: | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 |
| ZIP code: | 32669 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104873405 | 2006-05-30 | 2024-11-08 | 13575 NW 1ST LN STE 20, NEWBERRY, FL, 326693735, US | 13575 NW 1ST LN STE 20, NEWBERRY, FL, 326693735, US | |||||||||||||||||||||||||||||||
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| Phone | +1 352-332-5755 |
| Fax | 8559641167 |
Authorized person
| Name | PRESTON T GREEN |
| Role | PHYSICIAN |
| Phone | 3523325755 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED GROUP |
| Number | S1027207 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DG3096 |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 24544 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH FLORIDA HEART RETIREMENT PLAN | 2017 | 204869058 | 2018-07-27 | CARDIOVASCULAR HEALTH CONSULTANTS, PA | 7 | |||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2018-07-27 |
| Name of individual signing | EDUARD VANGELDER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3523325755 |
| Plan sponsor’s DBA name | NORTH FLORIDA HEART |
| Plan sponsor’s address | 350 NW 76TH DRIVE, SUITE B, GAINESVILLE, FL, 32607 |
Signature of
| Role | Plan administrator |
| Date | 2016-06-10 |
| Name of individual signing | EDUARD VANGELDER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GREEN, PRESTON T, Dr. | Agent | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 |
| Name | Role | Address |
|---|---|---|
| GREEN, PRESTON TMD | President | 13575 NW 1st Lane, Suite 20 Newberry, FL 32669 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000060169 | NORTH FLORIDA HEART | ACTIVE | 2019-05-21 | 2029-12-31 | No data | 13575 NW 1ST LANE, SUITE 20, NEWBERRY, FL, 32669 |
| G08109900278 | NORTH FLORIDA HEART | EXPIRED | 2008-04-18 | 2013-12-31 | No data | 150 NW 75TH DRIVE, SUITE A, GAINESVILLE, FL, 32607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-12-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-15 | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-15 | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-15 | 13575 NW 1st Lane, Suite 20, Newberry, FL 32669 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-03-27 | GREEN, PRESTON T, Dr. | No data |
| AMENDMENT | 2010-12-27 | No data | No data |
| REINSTATEMENT | 2010-10-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-06-15 |
| REINSTATEMENT | 2022-12-04 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-02-26 |
| ANNUAL REPORT | 2015-01-22 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
