| Entity Name: | MOUNTCASTLE VEIN CENTER OF ST. PETERSBURG, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Nov 2006 (18 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P06000144251 |
| FEI/EIN Number | 205885411 |
| Address: | 5901 SUN BLVD, 201, ST.PETERSBURG, FL, 33715 |
| Mail Address: | 5901 SUN BLVD, 201, ST.PETERSBURG, FL, 33715 |
| ZIP code: | 33715 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619022951 | 2007-01-25 | 2014-11-20 | 5901 SUN BLVD, SUITE 201, ST PETERSBURG, FL, 337151166, US | 5901 SUN BLVD, SUITE 113A, ST PETERSBURG, FL, 337151166, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 727-865-6941 |
| Fax | 7278640929 |
Authorized person
| Name | DR. DANIEL J MOUNTCASTLE |
| Role | PRESIDENT |
| Phone | 7278656941 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME36289 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 3027OT |
| State | FL |
| Issuer | MEDICAID |
| Number | 039342800 |
| State | FL |
| Issuer | MEDICAL LICENSE NUMBER |
| Number | ME36289 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOUNTCASTLE DANIEL J | Agent | 5901 SUN BLVD, ST.PETERSBURG, FL, 33715 |
| Name | Role | Address |
|---|---|---|
| MOUNTCASTLE DANIEL J | President | 5901 SUN BLVD, SUITE113A, ST.PETERSBURG, FL, 33715 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09058900199 | MOUNTCASTLE VEIN CENTER | EXPIRED | 2009-02-26 | 2014-12-31 | No data | 5901 SUN BLVD,, SUITE 113A, ST. PETERSBURG, FL, 33715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-06 | 5901 SUN BLVD, 201, ST.PETERSBURG, FL 33715 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-06 | 5901 SUN BLVD, 201, ST.PETERSBURG, FL 33715 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-06 | 5901 SUN BLVD, 201, ST.PETERSBURG, FL 33715 | No data |
| CANCEL ADM DISS/REV | 2009-02-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000101667 | ACTIVE | 1000000775117 | PINELLAS | 2018-03-02 | 2028-03-07 | $ 546.35 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LARGO SERVICE CENTER, 11351 ULMERTON RD STE 220, LARGO FL337781629 |
| J15000199089 | TERMINATED | 1000000653570 | PINELLAS | 2015-01-28 | 2035-02-05 | $ 10,577.36 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-03-10 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-04-13 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-03-31 |
| REINSTATEMENT | 2009-02-25 |
| Domestic Profit | 2006-11-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
