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  5. JOHN S. BRUNO, M.D., P.A.

JOHN S. BRUNO, M.D., P.A.

Company Details

Entity Name: JOHN S. BRUNO, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 20 Jun 1977 (48 years ago)
Document Number: 537541
FEI/EIN Number 591745972
Address: 15971 Glenisle way, FT. MYERS, FL, 33912, US
Mail Address: 15971 Glenisle way, FT. MYERS, FL, 33912, US
ZIP code: 33912
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790066967 2011-09-01 2011-09-01 2685 SWAMP CABBAGE CT, FORT MYERS, FL, 339019331, US 2685 SWAMP CABBAGE CT, FORT MYERS, FL, 339019331, US

Contacts
Phone +1 239-936-2522
Fax 2399367831

Authorized person
Name DR. JOHN S. BRUNO
Role PRESIDENT
Phone 2399362522

Taxonomy
Taxonomy Code 2086S0122X - Plastic and Reconstructive Surgery Physician
License Number ME13183
State FL
Is Primary Yes

Other Provider Identifiers
Issuer WELLCARE
Number 15670
State FL
Issuer MEDICARE RAILROAD
Number 242907206
State FL
Issuer MEDICARE
Number 78251
State FL
Issuer MEDICAID
Number 055527400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JOHN S. BRUNO, M.D., P.A., 401(K) PROFIT SHARING PLAN AND TRUST 2013 591745972 2015-01-19 JOHN S. BRUNO, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 2399362522
Plan sponsor’s address 15971 GLEN ISLE WAY, FORT MYERS, FL, 33912

Signature of
Role Plan administrator
Date 2015-01-19
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-01-19
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
JOHN S. BRUNO, M.D., P.A., 401(K) PROFIT SHARING PLAN AND TRUST 2012 591745972 2014-04-15 JOHN S. BRUNO, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 2399362522
Plan sponsor’s address 15971 GLEN ISLE WAY, FORT MYERS, FL, 33912

Signature of
Role Plan administrator
Date 2014-04-15
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-15
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
JOHN S. BRUNO, M.D., P.A., 401(K) PROFIT SHARING PLAN AND TRUST 2011 591745972 2013-04-15 JOHN S. BRUNO, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 2399362522
Plan sponsor’s address 2685 SWAMP CABBAGE COURT, FORT MYERS, FL, 33901

Plan administrator’s name and address
Administrator’s EIN 591745972
Plan administrator’s name JOHN S. BRUNO, M.D., P.A.
Plan administrator’s address 2685 SWAMP CABBAGE COURT, FORT MYERS, FL, 33901
Administrator’s telephone number 2399362522

Signature of
Role Plan administrator
Date 2013-04-15
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-15
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
JOHN S. BRUNO, M.D., P.A., 401(K) PROFIT SHARING PLAN AND TRUST 2010 591745972 2012-04-13 JOHN S. BRUNO, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 2399362522
Plan sponsor’s address 2685 SWAMP CABBAGE COURT, FORT MYERS, FL, 33901

Plan administrator’s name and address
Administrator’s EIN 591745972
Plan administrator’s name JOHN S. BRUNO, M.D., P.A.
Plan administrator’s address 2685 SWAMP CABBAGE COURT, FORT MYERS, FL, 33901
Administrator’s telephone number 2399362522

Signature of
Role Plan administrator
Date 2012-04-13
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-13
Name of individual signing JOHN BRUNO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BRUNO JOHN S Agent 15971 Glenisle way, FT. MYERS, FL, 33912

Director

Name Role Address
BRUNO JOHN S Director 15971 Glenisle way, FT. MYERS, FL, 33912

Manager

Name Role Address
BRUNO JOHN S Manager 15971 Glenisle way, FT. MYERS, FL, 33912

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data
AMENDMENT 2014-08-22 No data No data

Related by officers

BRUNO JOHN S

FORT MYERS PLASTIC SURGERY CENTER, P.A. FT. MYERS PLASTIC SURGERY CENTER, P.A.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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