| Entity Name: | COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 May 1994 (31 years ago) |
| Document Number: | P94000033895 |
| FEI/EIN Number | 561746429 |
| Address: | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Mail Address: | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245291988 | 2006-03-31 | 2020-01-07 | 7710 S US HIGHWAY 1, PORT SAINT LUCIE, FL, 349522320, US | 7710 S US HIGHWAY 1, PORT SAINT LUCIE, FL, 349522320, US | |||||||||||||||||||||
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| Phone | +1 772-335-5300 |
| Fax | 7728733004 |
Authorized person
| Name | EDWARD JESUS ROSSARIO |
| Role | PRESIDENT |
| Phone | 7723355300 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS GROUP |
| Number | 33747 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. SALARY SAVINGS AND RETIREMENT PLAN | 2018 | 561746429 | 2020-02-03 | COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. | 1 | |||||||||||||
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| COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. SALARY SAVINGS AND RETIREMENT PLAN | 2017 | 561746429 | 2020-02-03 | COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. | 59 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| ROSSARIO EDWARD JDr. | Agent | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| ROSSARIO EDWARD J | President | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| SHUTE GERALD C | Vice President | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| TROCCHIA ARON M | Treasurer | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| LUGO ROBERTO | Secretary | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| PUTNEY EMILY H | Director | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G96123000039 | COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER | ACTIVE | 1996-05-02 | 2026-12-31 | No data | 7710 SOUTH US HWY 1, PORT SAINT LUCIE, FL, 34952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 1996-05-24 | COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
