| Entity Name: | BEACHSIDE ANESTHESIA INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jan 2015 (10 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 30 Mar 2017 (8 years ago) |
| Document Number: | P15000010146 |
| FEI/EIN Number | 47-3011900 |
| Address: | 110 LONGWOOD AVE., ROCKLEDGE, FL, 32955, US |
| Mail Address: | P.O. BOX 320281, COCOA BEACH, FL, 32932, US |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164939971 | 2018-01-02 | 2018-01-02 | PO BOX 320281, COCOA BEACH, FL, 329320281, US | 95 BULLDOG BLVD, MELBOURNE, FL, 329013332, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 573-686-5550 |
| Phone | +1 321-729-9493 |
Authorized person
| Name | MARY MARGARET BOGER |
| Role | PRESIDENT |
| Phone | 3217838926 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE DEPT HEALTH |
| Number | ARNP9164912 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOGER MARY M | Agent | 110 LONGWOOD AVE., ROCKLEDGE, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| BOGER MARY M | President | P.O. BOX 320281, COCOA BEACH, FL, 32932 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000008609 | RESTORATIVE IV THERAPIES | ACTIVE | 2023-01-19 | 2028-12-31 | No data | PO BOX 320281, COCOA BEACH, FL, 32932 |
| G18000095573 | KETAMINE CARE | EXPIRED | 2018-08-27 | 2023-12-31 | No data | 1899 MURRELL ROAD, SUITE 130, ROCKLEDGE, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-18 | 110 LONGWOOD AVE., ROCKLEDGE, FL 32955 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-18 | 110 LONGWOOD AVE., ROCKLEDGE, FL 32955 | No data |
| AMENDMENT AND NAME CHANGE | 2017-03-30 | BEACHSIDE ANESTHESIA INC | No data |
| CHANGE OF MAILING ADDRESS | 2016-04-25 | 110 LONGWOOD AVE., ROCKLEDGE, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-03-05 |
| ANNUAL REPORT | 2019-03-14 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-07 |
| Amendment and Name Change | 2017-03-30 |
| ANNUAL REPORT | 2016-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
