| Entity Name: | PATRICK M. KELLEY, M.D., PLASTIC SURGERY CENTER, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Oct 1979 (45 years ago) |
| Document Number: | 638224 |
| FEI/EIN Number | 591944612 |
| Address: | 2677 FEROL LANE, LYNN HAVE, FL, 32444, US |
| Mail Address: | 2677 FEROL LANE, LYNN HAVE, FL, 32444, US |
| ZIP code: | 32444 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023327673 | 2010-09-30 | 2011-07-05 | 15 DOCTORS DR, PANAMA CITY, FL, 324054520, US | 15 DOCTORS DR, PANAMA CITY, FL, 324054520, US | |||||||||||||||||||
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| Phone | +1 850-769-8991 |
| Fax | 8507693708 |
Authorized person
| Name | DR. PATRICK MARK KELLEY |
| Role | PRESIDENT |
| Phone | 8507698991 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME0032802 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATRICK KELLEY, M.D. PLASTIC SURGERY CENTER, P.A. PROFIT SHARING PLAN | 2014 | 591944612 | 2016-02-02 | PATRICK M. KELLEY, M.D., PLASTIC SURGERY CENTER, P.A | 4 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2016-02-02 |
| Name of individual signing | PATRICK KELLEY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2016-02-02 |
| Name of individual signing | PATRICK KELLEY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1983-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8507698991 |
| Plan sponsor’s address | 15 DOCTORS DRIVE, PANAMA CITY, FL, 32405 |
Signature of
| Role | Plan administrator |
| Date | 2016-02-02 |
| Name of individual signing | PATRICK KELLEY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2016-02-02 |
| Name of individual signing | PATRICK KELLEY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| KELLEY, PATRICK M MD | Agent | 2677 FEROL LANE, LYNN HAVE, FL, 32444 |
| Name | Role | Address |
|---|---|---|
| KELLEY, PATRICK M MD | President | 2677 FEROL LANE, LYNN HAVE, FL, 32444 |
| Name | Role | Address |
|---|---|---|
| KELLEY, PATRICK M MD | Director | 2677 FEROL LANE, LYNN HAVE, FL, 32444 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-11-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REINSTATEMENT | 2021-10-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| NAME CHANGE AMENDMENT | 1980-09-02 | PATRICK M. KELLEY, M.D., PLASTIC SURGERY CENTER, P.A. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
