| 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 |
| 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 | |||||||||||||||||||||||||||||||
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| 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 |
| 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 | |||||||||||||||||||||||||||||||
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| 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 |
| 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 |
| 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 |
| 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 |
| 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 | - |
| 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
