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  5. RICHARD WEIZENECKER, M. D., P. A.

RICHARD WEIZENECKER, M. D., P. A.

Company Details

Entity Name: RICHARD WEIZENECKER, M. D., P. A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 02 Aug 1976 (49 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: 508227
FEI/EIN Number 59-1687595
Address: 1297 SW STATE RD 47, LAKE CITY, FL 32025
Mail Address: 1297 SW STATE RD 47, LAKE CITY, FL 32025
ZIP code: 32025
County: Columbia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1114351830 2013-08-29 2013-08-29 1297 SW STATE ROAD 47, LAKE CITY, FL, 320250484, US 1297 SW STATE ROAD 47, LAKE CITY, FL, 320250484, US

Contacts
Phone +1 386-752-4711
Fax 3867525075

Authorized person
Name DR. RICHARD ALBERT WEIZENECKER
Role PRESIDENT
Phone 3867524711

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME13858
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 054014500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2019 591687595 2020-01-14 RICHARD WEIZENECKER, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Signature of
Role Plan administrator
Date 2020-01-14
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2018 591687595 2019-04-18 RICHARD WEIZENECKER, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2019-04-18
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2017 591687595 2018-04-04 RICHARD WEIZENECKER, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2018-04-04
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2016 591687595 2017-06-05 RICHARD WEIZENECKER, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2017-06-05
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2015 591687595 2016-05-18 RICHARD WEIZENECKER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2016-05-18
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2014 591687595 2015-06-18 RICHARD WEIZENECKER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2015-06-18
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2013 591687595 2014-04-25 RICHARD WEIZENECKER, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2014-04-25
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2012 591687595 2013-03-28 RICHARD WEIZENECKER, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2013-03-28
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2011 591687595 2012-07-27 RICHARD WEIZENECKER, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2012-07-27
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature
RICHARD WEIZENECKER, M.D., P.A. PROFIT SHARING PLAN 2010 591687595 2011-05-26 RICHARD WEIZENECKER, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3867524711
Plan sponsor’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025

Plan administrator’s name and address
Administrator’s EIN 591687595
Plan administrator’s name RICHARD WEIZENECKER, M.D., P.A.
Plan administrator’s address 1297 S.W. STATE ROAD 47, LAKE CITY, FL, 32025
Administrator’s telephone number 3867524711

Signature of
Role Plan administrator
Date 2011-05-26
Name of individual signing RICHARD WEIZENECKER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WEIZENECKER, RICHARD Agent 1297 SW STATE RD 47, LAKE CITY, FL 32025

President

Name Role Address
WEIZENECKER, RICHARD President 1297 SW STATE RD 47, LAKE CITY, FL 32025

Director

Name Role Address
WEIZENECKER, RICHARD Director 1297 SW STATE RD 47, LAKE CITY, FL 32025

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
CHANGE OF PRINCIPAL ADDRESS 2005-02-09 1297 SW STATE RD 47, LAKE CITY, FL 32025 No data
CHANGE OF MAILING ADDRESS 2005-02-09 1297 SW STATE RD 47, LAKE CITY, FL 32025 No data
REGISTERED AGENT ADDRESS CHANGED 2005-02-09 1297 SW STATE RD 47, LAKE CITY, FL 32025 No data

Documents

Name Date
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-02-02
ANNUAL REPORT 2017-02-03
ANNUAL REPORT 2016-01-28
ANNUAL REPORT 2015-02-06
ANNUAL REPORT 2014-02-10
ANNUAL REPORT 2013-02-12
ANNUAL REPORT 2012-01-04
ANNUAL REPORT 2011-01-04
ANNUAL REPORT 2010-01-28

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 06 Feb 2025

Sources: Florida Department of State

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