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  5. RICHARD E. PROMIN MD PA

RICHARD E. PROMIN MD PA

Company Details

Entity Name: RICHARD E. PROMIN MD PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 03 Oct 1969 (55 years ago)
Document Number: 601509
FEI/EIN Number 591271578
Address: 2210 LAUREL RUN DR, OCALA, FL, 34471, US
Mail Address: 2210 LAUREL RUN DR, OCALA, FL, 34471, US
ZIP code: 34471
County: Marion
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1972834729 2010-01-19 2010-01-19 3301 SW 34TH CIR STE 301, OCALA, FL, 344746615, US 3301 SW 34TH CIR STE 301, OCALA, FL, 344746615, US

Contacts
Phone +1 352-629-0181
Fax 3526290587

Authorized person
Name DR. RICHARD E PROMIN
Role PRESIDENT
Phone 3526290181

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME10123
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 047439800
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RICHARD E. PROMIN, MD, PA PROFIT SHARING PLAN 2013 591271578 2014-12-23 RICHARD E. PROMIN, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1972-09-28
Business code 621111
Sponsor’s telephone number 3526290181
Plan sponsor’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474
RICHARD E. PROMIN, MD, PA PROFIT SHARING PLAN 2012 591271578 2014-03-14 RICHARD E. PROMIN, MD, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1972-09-28
Business code 621111
Sponsor’s telephone number 3526290181
Plan sponsor’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474

Signature of
Role Plan administrator
Date 2014-03-14
Name of individual signing RICHARD E. PROMIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-03-14
Name of individual signing RICHARD E. PROMIN
Valid signature Filed with authorized/valid electronic signature
RICHARD E. PROMIN, MD, PA PROFIT SHARING PLAN 2011 591271578 2013-07-15 RICHARD E. PROMIN, MD, PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1972-09-28
Business code 621111
Sponsor’s telephone number 3526290181
Plan sponsor’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474

Plan administrator’s name and address
Administrator’s EIN 591271578
Plan administrator’s name RICHARD E. PROMIN, MD, PA
Plan administrator’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474
Administrator’s telephone number 3526290181

Signature of
Role Plan administrator
Date 2013-07-15
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-15
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
RICHARD E. PROMIN, MD, PA PROFIT SHARING PLAN 2010 591271578 2012-01-17 RICHARD E. PROMIN, MD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1972-09-28
Business code 621111
Sponsor’s telephone number 3526290181
Plan sponsor’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474

Plan administrator’s name and address
Administrator’s EIN 591271578
Plan administrator’s name RICHARD E. PROMIN, MD, PA
Plan administrator’s address 3301 SE 34TH CIRCLE #301, OCALA, FL, 34474
Administrator’s telephone number 3526290181

Signature of
Role Plan administrator
Date 2012-01-17
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-01-17
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
RICHARD E. PROMIN, MD, PA PROFIT SHARING PLAN 2009 591271578 2011-07-12 RICHARD E. PROMIN, MD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1972-09-28
Business code 621111
Sponsor’s telephone number 3526290181
Plan sponsor’s address 3301 SE 34THCIRCLE #301, OCALA, FL, 34474

Plan administrator’s name and address
Administrator’s EIN 591271578
Plan administrator’s name RICHARD E. PROMIN, MD, PA
Plan administrator’s address 3301 SE 34THCIRCLE #301, OCALA, FL, 34474
Administrator’s telephone number 3526290181

Signature of
Role Plan administrator
Date 2011-07-12
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-12
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PROMIN RICHARD EMD Agent 2210 LAUREL RUN DR, OCALA, FL, 34471

President

Name Role Address
PROMIN RICHARD EMD President 2210 LAUREL RUN DR, OCALA, FL, 34471

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2017-02-10 No data No data
REINSTATEMENT 2014-10-07 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
CANCEL ADM DISS/REV 2010-03-23 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 No data No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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