| Entity Name: | TREASURE COAST THORACIC SURGERY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 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: | P97000107034 |
| FEI/EIN Number | 593493501 |
| Address: | 816 Hwy US 1, Sebastian, FL, 32958, US |
| Mail Address: | 816 Hwy US 1, Sebastian, FL, 32958, US |
| ZIP code: | 32958 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538155197 | 2005-09-20 | 2022-07-21 | 816 US HIGHWAY 1, SEBASTIAN, FL, 329584141, US | 816 US HIGHWAY 1, SEBASTIAN, FL, 329584141, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-581-5848 |
| Fax | 7725815849 |
Authorized person
| Name | DR. MICHAEL A GREENE |
| Role | PRESIDENT |
| Phone | 7725815848 |
Taxonomy
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373207000 |
| State | FL |
| Issuer | FL BCBS GROUP |
| Number | 21810 |
| State | FL |
| Issuer | MEDICAID |
| Number | 254440700 |
| State | FL |
| Issuer | MEDICARE RAILROAD ID |
| Number | 330004682 |
| Issuer | DR M GREENE BLUE SHIELD |
| Number | 68633 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TREASURE COAST THORACIC SURGERY, P.A. 401(K) PLAN | 2014 | 593493501 | 2015-10-15 | TREASURE COAST THORACIC SURGERY, P.A. | 7 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-10-15 |
| Name of individual signing | MICHAEL GREENE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Greene Michael Dr. | Agent | 816 Hwy US 1, Sebastian, FL, 32958 |
| Name | Role | Address |
|---|---|---|
| GREENE MICHAEL ADr. | President | 816 Hwy US 1, Sebastian, FL, 32958 |
| Name | Role | Address |
|---|---|---|
| GREENE MICHAEL ADr. | Director | 816 Hwy US 1, Sebastian, FL, 32958 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-13 | 816 Hwy US 1, Sebastian, FL 32958 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-13 | 816 Hwy US 1, Sebastian, FL 32958 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-01-13 | Greene, Michael, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-13 | 816 Hwy US 1, Sebastian, FL 32958 | No data |
| NAME CHANGE AMENDMENT | 2013-10-01 | TREASURE COAST THORACIC SURGERY, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-01-13 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-13 |
| Off/Dir Resignation | 2013-12-09 |
| Name Change | 2013-10-01 |
| ANNUAL REPORT | 2013-02-18 |
| ANNUAL REPORT | 2012-03-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
