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COASTAL CARE MEDICAL CENTER, INC.

COASTAL CARE MEDICAL CENTER, INC.

Company Details

Entity Name:	COASTAL CARE MEDICAL CENTER, INC.
Jurisdiction:	FLORIDA
Filing Type:	Florida Profit Corporation
Status:	Inactive
Date Filed:	11 Dec 1997 (27 years ago)
Date of dissolution:	25 Sep 2020 (4 years ago)
Last Event:	ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed:	25 Sep 2020 (4 years ago)
Document Number:	P97000104592
FEI/EIN Number	59-3489059
Address:	11761 BEACH BOULEVARD, SUITE 8, JACKSONVILLE, FL 32246
Mail Address:	11761 BEACH BOULEVARD, SUITE 8, JACKSONVILLE, FL 32246
ZIP code:	32246
County:	Duval
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1902970684

2006-11-17

2016-01-06

11761 BEACH BLVD, SUITE 8, JACKSONVILLE, FL, 322466615, US

Contacts

Phone	+1 904-642-3304
Fax	9049283561

Authorized person

Name	DR. CLINT D MILLER
Role	PRESIDENT
Phone	9046423304

Taxonomy

Taxonomy Code	207Q00000X - Family Medicine Physician
Is Primary	Yes

Agent

Name	Role	Address
MILLER, CLINT D	Agent	5353 DIXIE LANDING DR, JACKSONVILLE, FL 32224

President

Name	Role	Address
MILLER, CLINT	President	5353 DIXIE LANDING DRIVE, JACKSONVILLE, FL 32224

Secretary

Name	Role	Address
MILLER, CLINT	Secretary	5353 DIXIE LANDING DRIVE, JACKSONVILLE, FL 32224

Treasurer

Name	Role	Address
MILLER, CLINT	Treasurer	5353 DIXIE LANDING DRIVE, JACKSONVILLE, FL 32224

Events

Event Type	Filed Date	Value	Description
ADMIN DISSOLUTION FOR ANNUAL REPORT	2020-09-25	No data	No data
CHANGE OF PRINCIPAL ADDRESS	2013-04-16	11761 BEACH BOULEVARD, SUITE 8, JACKSONVILLE, FL 32246	No data
CHANGE OF MAILING ADDRESS	2013-04-16	11761 BEACH BOULEVARD, SUITE 8, JACKSONVILLE, FL 32246	No data
REGISTERED AGENT ADDRESS CHANGED	2009-03-27	5353 DIXIE LANDING DR, JACKSONVILLE, FL 32224	No data
NAME CHANGE AMENDMENT	2005-05-16	COASTAL CARE MEDICAL CENTER, INC.	No data
REGISTERED AGENT NAME CHANGED	1998-07-31	MILLER, CLINT D	No data

Debts

Document Number	Status	Case Number	Name of Court	Date of Entry	Expiration Date	Amount Due	Plaintiff
J09000813153	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-03-05	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000220516	TERMINATED	1000000104456	14734 2346	2008-12-26	2029-01-22	$ 6,813.14	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000457365	ACTIVE	1000000104455	14734 2362	2008-12-26	2029-01-28	$ 408.52	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000457373	ACTIVE	1000000104456	14734 2346	2008-12-26	2029-01-28	$ 6,813.14	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000532035	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-02-04	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000532043	TERMINATED	1000000104456	14734 2346	2008-12-26	2029-02-04	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000606854	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-02-11	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000606862	TERMINATED	1000000104456	14734 2346	2008-12-26	2029-02-11	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J09000680800	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-02-18	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000680818	TERMINATED	1000000104456	14734 2346	2008-12-26	2029-02-18	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000755172	TERMINATED	1000000104455	14734 2362	2008-12-26	2014-02-25	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000755180	TERMINATED	1000000104456	14734 2346	2008-12-26	2014-02-25	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000872894	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-03-11	$ 20.00	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825
J09000220508	TERMINATED	1000000104455	14734 2362	2008-12-26	2029-01-22	$ 408.52	STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE A-250, JACKSONVILLE FL322096804
J08900009411	LAPSED	16-2006CA-5426	4 JUD CIR DUVAL CTY, FL	2008-05-12	2013-05-27	$117377.43	EQUITY BANK, S.S.B., 5220 SPRING VALLEY ROAD, SUITE 415, DALLAS, FL 75254

Documents

Name	Date
ANNUAL REPORT	2019-04-09
ANNUAL REPORT	2018-04-03
ANNUAL REPORT	2017-07-14
ANNUAL REPORT	2016-04-15
ANNUAL REPORT	2015-04-08
ANNUAL REPORT	2014-03-19
ANNUAL REPORT	2013-04-16
ANNUAL REPORT	2012-03-29
ANNUAL REPORT	2011-04-13
ANNUAL REPORT	2010-03-25
ANNUAL REPORT	2009-03-27
ANNUAL REPORT	2008-08-27
ANNUAL REPORT	2007-04-23
ANNUAL REPORT	2006-04-27
Name Change	2005-05-16
ANNUAL REPORT	2005-04-25
ANNUAL REPORT	2004-05-10
ANNUAL REPORT	2003-02-27
ANNUAL REPORT	2002-05-28
ANNUAL REPORT	2001-04-11

Date of last update: 01 Feb 2025

Sources: Florida Department of State