| Entity Name: | COASTAL PAIN MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Nov 2017 (7 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P17000088013 |
| FEI/EIN Number | 82-3276904 |
| Address: | 100 EAST SAMPLE RD, SUITE 200, POMPANO BEACH, FL, 33064, US |
| Mail Address: | 100 EAST SAMPLE RD, SUITE 200, POMPANO BEACH, FL, 33064, US |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144735267 | 2017-12-12 | 2018-01-10 | 11244 TURNBRIDGE DR, JACKSONVILLE, FL, 322562342, US | 100 E SAMPLE RD STE 200, POMPANO BEACH, FL, 330643554, US | |||||||||||||||||
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| Phone | +1 904-591-4150 |
| Phone | +1 954-543-5100 |
| Fax | 9545435994 |
Authorized person
| Name | JONATHAN COIT KRUG |
| Role | DIRECTOR |
| Phone | 9045914150 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KRUG JONATHAN C | Agent | 100 EAST SAMPLE RD, POMPANO BEACH, FL, 33064 |
| Name | Role | Address |
|---|---|---|
| KRUG JONATHAN C | Director | 100 EAST SAMPLE RD, POMPANO BEACH, FL, 33064 |
| LONGOBARDI MONICA | Director | 19538 BLACK OLIVE LANE, BOCA RATON, FL, 33498 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-17 | 100 EAST SAMPLE RD, SUITE 200, POMPANO BEACH, FL 33064 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-17 | 100 EAST SAMPLE RD, SUITE 200, POMPANO BEACH, FL 33064 | No data |
| AMENDMENT | 2017-12-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-18 |
| Amendment | 2017-12-14 |
| Domestic Profit | 2017-11-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
