| Entity Name: | THE EMERALD COAST NECK & BACK CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
THE EMERALD COAST NECK & BACK CLINIC, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 10 Mar 1999 (26 years ago) |
| Document Number: | P99000023752 |
| FEI/EIN Number |
593562781
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1003 College Blvd. W, Suite 4, Niceville, FL, 32578, US |
| Mail Address: | 1003 College Blvd. W, Suite 4, Niceville, FL, 32578, US |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386916237 | 2012-02-07 | 2022-12-29 | 1003 COLLEGE BLVD W, SUITE 4, NICEVILLE, FL, 325781068, US | 1003 COLLEGE BLVD W, SUITE 4, NICEVILLE, FL, 325781068, US | |||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 850-279-6485 |
| Fax | 8502796546 |
Authorized person
| Name | CHRISTO W. KOULISIS |
| Role | PRESIDENT |
| Phone | 8502796485 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | ME0053933 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| License Number | ME0053933 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DEPARTMENT OF LABOR |
| Number | 162510700 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 07915 |
| State | FL |
| Issuer | MEDICAID |
| Number | 256355000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Koulisis Christo WDr. | Agent | 1003 College Blvd. W, Niceville, FL, 32578 |
| KOULISIS CHRISTO W | Director | 1003 College Blvd. W, Niceville, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-08 | Koulisis, Christo W, Dr. | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-12 | 1003 College Blvd. W, Suite 4, Niceville, FL 32578 | - |
| CHANGE OF MAILING ADDRESS | 2013-04-23 | 1003 College Blvd. W, Suite 4, Niceville, FL 32578 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-23 | 1003 College Blvd. W, Suite 4, Niceville, FL 32578 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 01 May 2025
Sources: Florida Department of State
