| Entity Name: | EAST COAST ORTHOTICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Aug 1995 (29 years ago) |
| Document Number: | P95000060745 |
| FEI/EIN Number | 593324110 |
| Address: | 10910 DOMAIN DR STE 300, AUSTIN, TX, 78758, US |
| Mail Address: | 10910 DOMAIN DR., SUITE 300, AUSTIN, TX, 78758 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194864850 | 2007-02-06 | 2013-05-15 | 129 W HIBISCUS BLVD STE N, MELBOURNE, FL, 329013006, US | 129 W HIBISCUS BLVD STE N, MELBOURNE, FL, 329013006, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-724-5411 |
| Fax | 3217246551 |
Authorized person
| Name | MS. SHERYL PRICE |
| Role | DIRECTOR OF REIMBURSEMENT |
| Phone | 5034938288 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | ORT 2 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | M2332 |
| State | FL |
| Issuer | AETNA PPO |
| Number | 5290148 |
| State | FL |
| Issuer | AETNA |
| Number | 0966993 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| LIANG SAMUEL M | President | 10910 DOMAIN DR STE 300, AUSTIN, TX, 78758 |
| Name | Role | Address |
|---|---|---|
| KIRALY THOMAS E | Vice President | 10910 DOMAIN DR., AUSTIN, TX, 78758 |
| Name | Role | Address |
|---|---|---|
| MESTIER LOUIS J | Asst | 10910 DOMAIN DR., AUSTIN, TX, 78758 |
| Name | Role | Address |
|---|---|---|
| ASAR VINIT | Director | 10910 DOMAIN DR STE 300, AUSTIN, TX, 78758 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000055390 | HANGER CLINIC | EXPIRED | 2013-06-07 | 2018-12-31 | No data | 10910 DOMAIN DRIVE,SUITE 300, AUSTIN, TX, 78758 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2015-12-18 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS F97000003476. MERGER NUMBER 300000156663 |
| AMENDMENT | 2013-05-07 | No data | No data |
| NAME CHANGE AMENDMENT | 1997-02-28 | EAST COAST ORTHOTICS, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
