| Entity Name: | OKALOOSA CARDIOLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
OKALOOSA CARDIOLOGY, 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: | 08 Nov 1991 (33 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Nov 2002 (22 years ago) |
| Document Number: | S92998 |
| FEI/EIN Number |
593093454
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL, 32539, US |
| Mail Address: | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL, 32539, US |
| ZIP code: | 32539 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144270240 | 2006-05-11 | 2011-08-25 | 129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL, 325395350, US | 129 E REDSTONE AVE, SUITE A, CRESTVIEW, FL, 325395350, US | |||||||||||||||||||||||
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| Phone | +1 850-682-7212 |
Authorized person
| Name | DONNA M GIBSON |
| Role | BILLING MANAGER |
| Phone | 8506827212 |
Taxonomy
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| Is Primary | Yes |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 258928100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Al-Dehneh Anthony SDO | President | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL, 32539 |
| YOUSSEF GEORGE AMD | Vice President | 129 EAST REDSTONE AVENUE, CRESTVIEW, FL, 32539 |
| Al-Dehneh Anthony SDO | Agent | 129 EAST REDSTONE AVENUE, CRESTVIEW, FL, 32539 |
| Henien Shady SMD | Secretary | 129 EAST REDSTONE AVENUE, CRESTVIEW, FL, 32539 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000077824 | OKALOOSA HEART & VASCULAR CENTER | ACTIVE | 2019-07-18 | 2029-12-31 | - | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL, 32539 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-11 | Al-Dehneh, Anthony S, DO | - |
| REGISTERED AGENT ADDRESS CHANGED | 2008-10-06 | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL 32539 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-29 | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL 32539 | - |
| CHANGE OF MAILING ADDRESS | 2008-01-29 | 129 EAST REDSTONE AVENUE, SUITE A, CRESTVIEW, FL 32539 | - |
| REINSTATEMENT | 2002-11-04 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2002-10-04 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-06-09 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-27 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5335717109 | 2020-04-13 | 0491 | PPP | 129 E REDSTONE AVE, STE A, CRESTVIEW, FL, 32539-5350 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 May 2025
Sources: Florida Department of State
