| Entity Name: | BRAD MCCOLLOM, DO, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Sep 2013 (11 years ago) |
| Document Number: | P13000079678 |
| FEI/EIN Number | 46-3587201 |
| Address: | 1950 SPOTTED OWL DRIVE SW, VERO BEACH, FL, 32962 |
| Mail Address: | 1950 SPOTTED OWL DRIVE SW, VERO BEACH, FL, 32962 |
| ZIP code: | 32962 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528724176 | 2021-11-09 | 2021-11-09 | 2047 PALM BEACH LAKES BLVD, WEST PALM BEACH, FL, 334096522, US | 2047 PALM BEACH LAKES BLVD, WEST PALM BEACH, FL, 334096522, US | |||||||||||||
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| Phone | +1 561-507-0800 |
Authorized person
| Name | CARIANNE YANTZ |
| Role | HR |
| Phone | 5615070800 |
Taxonomy
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRAD MCCOLLOM DO, PA | 2023 | 463587201 | 2024-09-03 | BRAD MCCOLLOM DO, PA | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-03 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| McCollom Brad e | Agent | 1950 SPOTTED OWL DRIVE SW, VERO BEACH, FL, 32962 |
| Name | Role | Address |
|---|---|---|
| MCCOLLOM BRAD E | President | 1950 SPOTTED OWL DRIVE SW, VERO BEACH, FL, 32962 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2017-03-21 | McCollom, Brad e | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-21 | 1950 SPOTTED OWL DRIVE SW, VERO BEACH, FL 32962 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-03-12 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-02-09 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-03-04 |
| ANNUAL REPORT | 2015-03-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
