| Entity Name: | FIRST COAST SPINE, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Sep 2014 (10 years ago) |
| Document Number: | P14000077564 |
| FEI/EIN Number | 47-1887823 |
| Address: | 4849 French St., Jacksonville, FL, 32205, US |
| Mail Address: | 1201 Lake Asbury Drive, Green Cove Springs, FL, 32043, US |
| ZIP code: | 32205 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144625724 | 2014-10-25 | 2021-11-24 | 2650 MOSLEY RD, ORANGE PARK, FL, 320657503, US | 4849 FRENCH ST STE 1, JACKSONVILLE, FL, 322055003, US | |||||||||||||||||||||||||||
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| Phone | +1 904-600-3426 |
| Fax | 9048001432 |
Authorized person
| Name | COLT MITCHELL ANDREA |
| Role | PRESIDENT |
| Phone | 9046003426 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH10319 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLUE SKY 401(K) TRUST | 2023 | 471887823 | 2024-07-30 | FIRST COAST SPINE, INC. | 3 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 521328716 |
| Plan administrator’s name | TEFRA, INC. |
| Plan administrator’s address | 1 BURNHAM WOOD CT, PO BOX 4160, ANNAPOLIS, MD, 21403 |
| Administrator’s telephone number | 4102637644 |
Signature of
| Role | Plan administrator |
| Date | 2024-07-30 |
| Name of individual signing | LINDA S MATHIEU, PRES. TEFRA, INC. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621310 |
| Sponsor’s telephone number | 9046003426 |
| Plan sponsor’s address | 2650 MOSLEY ROAD, ORANGE PARK, FL, 32065 |
Plan administrator’s name and address
| Administrator’s EIN | 521328716 |
| Plan administrator’s name | TEFRA, INC. |
| Plan administrator’s address | 1 BURNHAM WOOD CT, PO BOX 4160, ANNAPOLIS, MD, 21403 |
| Administrator’s telephone number | 4102637644 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-15 |
| Name of individual signing | LINDA S MATHIEU, PRES. TEFRA, INC. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Andrea Colt | Agent | 4849 French St., Jacksonville, FL, 32205 |
| Name | Role | Address |
|---|---|---|
| ANDREA COLT | President | 1201 Lake Asbury Drive, Green Cove Springs, FL, 32043 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000063554 | SPEARHEAD | EXPIRED | 2017-06-07 | 2022-12-31 | No data | 2650 MOSLEY RD., ORANGE PARK, FL, 32065 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-01-27 | 4849 French St., Ste.1, Jacksonville, FL 32205 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-09 | 4849 French St., Ste.1, Jacksonville, FL 32205 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-09 | Andrea, Colt | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-09 | 4849 French St., Ste.1, Jacksonville, FL 32205 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-02-27 |
| ANNUAL REPORT | 2018-02-19 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-03-14 |
| ANNUAL REPORT | 2015-03-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
