| Entity Name: | EMERALD COAST PEDIATRICS & ADOLESCENTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 May 2011 (14 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 21 Mar 2016 (9 years ago) |
| Document Number: | P11000045245 |
| FEI/EIN Number | 45-2662997 |
| Address: | 621 West Baldwin Road, PANAMA CITY, FL, 32405, US |
| Mail Address: | P O Box 15937, PANAMA CITY, FL, 32406, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790130250 | 2016-05-03 | 2016-05-03 | 621 W BALDWIN RD STE A, PANAMA CITY, FL, 324053364, US | 621 W BALDWIN RD STE A, PANAMA CITY, FL, 324053364, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-747-3661 |
| Fax | 8507470194 |
Authorized person
| Name | EEHAB A KENAWY |
| Role | OWNER |
| Phone | 8507473661 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME86651 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266831900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KENAWY EEHAB A | Agent | 621 W Baldwin Road, Panama City, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| KENAWY EEHAB A | President | 621 W Baldwin Road, Panama City, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-26 | 621 West Baldwin Road, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-26 | 621 W Baldwin Road, Panama City, FL 32405 | No data |
| AMENDMENT AND NAME CHANGE | 2016-03-21 | EMERALD COAST PEDIATRICS & ADOLESCENTS, INC. | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-21 | 621 West Baldwin Road, PANAMA CITY, FL 32405 | No data |
| REINSTATEMENT | 2012-10-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-16 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-03-28 |
| ANNUAL REPORT | 2016-03-21 |
| Amendment and Name Change | 2016-03-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
