| Entity Name: | SUNCOAST VASCULAR CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Feb 1998 (27 years ago) |
| Document Number: | P98000015639 |
| Address: | 505 SOUTH FLAGLER DRIVE, SUITE 1330, WEST PALM BEACH, FL, 33401 |
| Mail Address: | 505 SOUTH FLAGLER DRIVE, SUITE 1330, WEST PALM BEACH, FL, 33401 |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164598678 | 2006-11-27 | 2020-08-22 | 840 US HIGHWAY ONE #210, ATTN AMBER KENNEDY, NORTH PALM BEACH, FL, 334083830, US | 3722 CENTRAL AVE, SUITE 6, FT MYERS, FL, 339018247, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 561-626-9021 |
| Fax | 5616267593 |
| Phone | +1 239-277-7700 |
| Fax | 2392777070 |
Authorized person
| Name | DR. MARC J GOULET |
| Role | CEO |
| Phone | 9544393465 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC BS |
| Number | 50648 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROGERS ALLISON B | Agent | 505 SOUTH FLAGLER DRIVE, SUITE 1330, WEST PALM BEACH, FL, 33401 |
| Name | Role | Address |
|---|---|---|
| MYERS WILLIAM E | Vice President | 1314 KENSINGTON ST, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| VLACHOS JAMES C | President | 1131 MORNINGSIDE PLACE, SARASOTA, FL, 34236 |
| Name | Role | Address |
|---|---|---|
| VLACHOS JAMES C | Treasurer | 1131 MORNINGSIDE PLACE, SARASOTA, FL, 34236 |
| Name | Role | Address |
|---|---|---|
| VLACHOS JAMES C | Director | 1131 MORNINGSIDE PLACE, SARASOTA, FL, 34236 |
| MYERS WILLIAM E | Director | 1314 KENSINGTON ST, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| MYERS WILLIAM E | Secretary | 1314 KENSINGTON ST, PORT CHARLOTTE, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| NAME CHANGE AMENDMENT | 1998-03-12 | SUNCOAST VASCULAR CLINIC, INC. | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
