| Entity Name: | SHORELINE MEDICAL GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 05 May 1995 (30 years ago) |
| Date of dissolution: | 02 Apr 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Apr 2019 (6 years ago) |
| Document Number: | P95000035256 |
| FEI/EIN Number | 59-3312087 |
| Address: | 419 BALTZELL AVE, PORT ST JOE, FL 32456 |
| Mail Address: | 419 BALTZELL AVE, PORT ST JOE, FL 32456 |
| ZIP code: | 32456 |
| County: | Gulf |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427160571 | 2006-08-31 | 2018-12-19 | 419 BALTZELL AVE, PORT ST JOE, FL, 324561864, US | 419 BALTZELL AVE, PORT ST JOE, FL, 32456, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-229-8010 |
| Fax | 8502273177 |
Authorized person
| Name | DR. THOMAS L CURRY |
| Role | PRESIDENT |
| Phone | 8502298010 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID RHC |
| Number | 377827401 |
| State | FL |
| Issuer | MEDICARE RHC |
| Number | 10-3887 |
| Issuer | MEDICAID |
| Number | 377827400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CURRY, THOMAS L | Agent | 419 BALTZELL AVE, PORT ST JOE, FL 32456 |
| Name | Role | Address |
|---|---|---|
| CURRY, THOMAS L | Director | 7192 WINDWARD ST, PORT ST JOE, FL 32456 |
| CURRY, ELIZABETH F | Director | 7192 WINDWARD ST, PORT ST JOE, FL 32456 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-02 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2000-04-18 | 419 BALTZELL AVE, PORT ST JOE, FL 32456 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1998-03-19 | 419 BALTZELL AVE, PORT ST JOE, FL 32456 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1998-03-19 | 419 BALTZELL AVE, PORT ST JOE, FL 32456 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-04-02 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-04-06 |
| ANNUAL REPORT | 2015-04-14 |
| ANNUAL REPORT | 2014-04-25 |
| ANNUAL REPORT | 2013-04-17 |
| ANNUAL REPORT | 2012-02-26 |
| ANNUAL REPORT | 2011-03-31 |
| ANNUAL REPORT | 2010-04-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
