| Entity Name: | PALM BAY PEDIATRICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Jul 1998 (27 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P98000060933 |
| FEI/EIN Number | 593520087 |
| Address: | 775 MALABAR RD, MALABAR, FL, 32950, US |
| Mail Address: | 775 MALABAR RD, MALABAR, FL, 32950, US |
| ZIP code: | 32950 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770731291 | 2008-09-09 | 2008-09-09 | 775 MALABAR RD, MALABAR, FL, 329503120, US | 775 MALABAR RD, MALABAR, FL, 329503120, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-722-8435 |
| Fax | 3217228486 |
Authorized person
| Name | DR. DORIS MARGARITA LEEDY |
| Role | OWNER/PHYSICIAN |
| Phone | 3217228435 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME63747 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2080P0205X - Pediatric Endocrinology Physician |
| License Number | ME63747 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 632833 |
| State | FL |
| Issuer | UPIN |
| Number | E41429 |
| State | FL |
| Issuer | CIGNA |
| Number | 3736201002 |
| State | FL |
| Issuer | MEDICAID |
| Number | 372797100 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 18683 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEEDY DORIS | Agent | 2635 SMITH LANE, MALABAR, FL, 32950 |
| Name | Role | Address |
|---|---|---|
| LEEDY DORIS M | Director | 775 MALABAR RD, MALABAR, FL, 32950 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-29 | 2635 SMITH LANE, MALABAR, FL 32950 | No data |
| REINSTATEMENT | 2008-03-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2008-03-27 | LEEDY, DORIS | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| REINSTATEMENT | 2005-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-04-01 | 775 MALABAR RD, MALABAR, FL 32950 | No data |
| CHANGE OF MAILING ADDRESS | 2002-04-01 | 775 MALABAR RD, MALABAR, FL 32950 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000873142 | TERMINATED | 1000000498383 | BREVARD | 2013-04-24 | 2023-05-03 | $ 720.80 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, COCOA SERVICE CENTER, 2428 CLEARLAKE RD STE M, COCOA FL329225731 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-09-14 |
| ANNUAL REPORT | 2010-04-29 |
| ANNUAL REPORT | 2009-04-29 |
| REINSTATEMENT | 2008-03-27 |
| REINSTATEMENT | 2005-10-18 |
| ANNUAL REPORT | 2002-04-01 |
| ANNUAL REPORT | 2001-01-31 |
| ANNUAL REPORT | 2000-07-21 |
| ANNUAL REPORT | 1999-05-06 |
| Domestic Profit | 1998-07-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
