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IRVIN C. BEMBRY, M. D., P. A. - Florida Company Profile

Company Details

Entity Name: IRVIN C. BEMBRY, M. D., P. A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

IRVIN C. BEMBRY, M. D., 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: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 29 Jun 1977 (48 years ago)
Date of dissolution: 09 Jan 2012 (13 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 09 Jan 2012 (13 years ago)
Document Number: 538259
FEI/EIN Number 591751948

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: DOCTORS' CLINIC, 5TH AVENUE, 413 N.W. 5TH AVE., JASPER, FL, 32052
Mail Address: DOCTORS' CLINIC, 5TH AVENUE, P.O. BOX 1028, JASPER, FL, 32052
ZIP code: 32052
County: Hamilton
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1306174396 2009-12-02 2009-12-02 PO BOX 1028, JASPER, FL, 320521028, US 413 5TH AVE NW, JASPER, FL, 320527801, US

Contacts

Phone +1 386-792-2985
Fax 3867920833

Authorized person

Name DR. IRVIN C BEMBRY
Role PRESIDENT
Phone 3867922985

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 22041
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 055712900
State FL
Issuer BLUE CROSS AND BLUE SHIELD OF FL.
Number 18882
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
IRVIN C. BEMBRY, MD, PA PROFIT SHARING PLAN 2011 591751948 2012-08-01 IRVIN C. BEMBRY, M.D. P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 3867922985
Plan sponsor’s address P.O. BOX 1028, JASPER, FL, 320521028

Plan administrator’s name and address

Administrator’s EIN 591751948
Plan administrator’s name IRVIN C. BEMBRY, M.D. P.A.
Plan administrator’s address P.O. BOX 1028, JASPER, FL, 320521028
Administrator’s telephone number 3867922985

Signature of

Role Plan administrator
Date 2012-08-01
Name of individual signing IRVIN BEMBRY
Valid signature Filed with authorized/valid electronic signature
IRVIN C. BEMBRY, MD, PA PROFIT SHARING PLAN 2010 591751948 2011-08-15 IRVIN C. BEMBRY, M.D. P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 3867922985
Plan sponsor’s address P.O. BOX 1028, JASPER, FL, 320521028

Plan administrator’s name and address

Administrator’s EIN 591751948
Plan administrator’s name IRVIN C. BEMBRY, M.D. P.A.
Plan administrator’s address P.O. BOX 1028, JASPER, FL, 320521028
Administrator’s telephone number 3867922985

Signature of

Role Plan administrator
Date 2011-08-15
Name of individual signing IRVIN BEMBRY
Valid signature Filed with authorized/valid electronic signature
IRVIN C. BEMBRY, MD, PA PROFIT SHARING PLAN 2009 591751948 2010-08-16 IRVIN C. BEMBRY, M.D. P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1977-07-01
Business code 621111
Sponsor’s telephone number 3867922985
Plan sponsor’s address P.O. BOX 1028, JASPER, FL, 320521028

Plan administrator’s name and address

Administrator’s EIN 591751948
Plan administrator’s name IRVIN C. BEMBRY, M.D. P.A.
Plan administrator’s address P.O. BOX 1028, JASPER, FL, 320521028
Administrator’s telephone number 3867922985

Signature of

Role Plan administrator
Date 2010-08-16
Name of individual signing IRVIN BEMBRY
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
BEMBRY, IRVIN C. Director 413 N.W. 5TH AVE, JASPER, FL, 32052
BEMBRY, IRVIN C. President 413 N.W. 5TH AVE, JASPER, FL, 32052
BEMBRY, IRVIN C. Agent DOCTORS' CLINIC, 5TH AVENUE, JASPER, FL, 32052

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2012-01-09 - -
CHANGE OF PRINCIPAL ADDRESS 2009-01-08 DOCTORS' CLINIC, 5TH AVENUE, 413 N.W. 5TH AVE., JASPER, FL 32052 -
CHANGE OF MAILING ADDRESS 2009-01-08 DOCTORS' CLINIC, 5TH AVENUE, 413 N.W. 5TH AVE., JASPER, FL 32052 -
REGISTERED AGENT ADDRESS CHANGED 2009-01-08 DOCTORS' CLINIC, 5TH AVENUE, 413 N.W. 5TH AVE, JASPER, FL 32052 -

Documents

Name Date
Voluntary Dissolution 2012-01-09
ANNUAL REPORT 2011-01-04
ANNUAL REPORT 2010-01-12
ANNUAL REPORT 2009-01-08
ANNUAL REPORT 2008-01-25
ANNUAL REPORT 2007-01-11
ANNUAL REPORT 2006-03-08
ANNUAL REPORT 2005-02-01
ANNUAL REPORT 2004-02-04
ANNUAL REPORT 2003-02-05

Date of last update: 03 Mar 2025

Sources: Florida Department of State