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  5. ACKERMAN CANCER CENTER, P.A.

ACKERMAN CANCER CENTER, P.A.

Company Details

Entity Name: ACKERMAN CANCER CENTER, P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 30 May 1980 (45 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 11 Aug 2014 (10 years ago)
Document Number: 671811
FEI/EIN Number 59-2037695
Address: 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223
Mail Address: 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223
ZIP code: 32223
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1134145659 2006-07-15 2023-07-13 1340 S 18TH ST, SUITE 103, FERNANDINA BEACH, FL, 320344799, US 1340 S 18TH ST, SUITE 103, FERNANDINA BEACH, FL, 320344799, US

Contacts
Phone +1 904-277-2700
Fax 9042772220

Authorized person
Name DR. SCOT N ACKERMAN
Role PRESIDENT
Phone 9048805522

Taxonomy
Taxonomy Code 2085R0001X - Radiation Oncology Physician
Is Primary Yes

Other Provider Identifiers
Issuer AETNA HMO
Number 0680444
State FL
Issuer AETNA PPO
Number 4643435
State FL
Issuer MEDICAID
Number 300037956E
State GA
Issuer MEDICAID
Number 253854703
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ACKERMAN CANCER CENTER, P.A. 401(K) PLAN AND TRUST 2023 592037695 2024-06-29 ACKERMAN CANCER CENTER, P.A. 104
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 9043087411
Plan sponsor’s address 10881 SAN JOSE BLVD,, JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2024-06-29
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A. SHORT SERVICE PLAN 2023 592037695 2024-06-29 ACKERMAN CANCER CENTER, P.A. 73
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2024-06-29
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A.401K PLAN AND TRUST 2022 592037695 2023-07-25 ACKERMAN CANCER CENTER, P.A. 108
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2023-07-25
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A. SHORT SERVICE PLAN 2022 592037695 2023-07-25 ACKERMAN CANCER CENTER, P.A. 58
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2023-07-25
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A.401K PLAN AND TRUST 2021 592037695 2022-09-28 ACKERMAN CANCER CENTER, P.A. 100
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2022-09-28
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A. SHORT SERVICE PLAN 2021 592037695 2022-07-28 ACKERMAN CANCER CENTER, P.A. 56
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A.401K PLAN AND TRUST 2021 592037695 2022-07-28 ACKERMAN CANCER CENTER, P.A. 100
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing KEVIN CHEEZUM
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A.401K PLAN AND TRUST 2020 592037695 2021-09-28 ACKERMAN CANCER CENTER, P.A. 113
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2021-09-28
Name of individual signing SCOT N. ACKERMAN, M.D.
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A. SHORT SERVICE PLAN 2020 592037695 2021-09-28 ACKERMAN CANCER CENTER, P.A. 62
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2021-09-28
Name of individual signing SCOT N. ACKERMAN, M.D.
Valid signature Filed with authorized/valid electronic signature
ACKERMAN CANCER CENTER, P.A. SHORT SERVICE PLAN 2019 592037695 2020-09-14 ACKERMAN CANCER CENTER, P.A. 49
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 9043879525
Plan sponsor’s address 10881 SAN JOSE BLVD., JACKSONVILLE, FL, 32223

Signature of
Role Plan administrator
Date 2020-09-14
Name of individual signing SCOT N. ACKERMAN, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ACKERMAN, SACHA Agent 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

President

Name Role Address
ACKERMAN, SCOT N President 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

Treasurer

Name Role Address
ACKERMAN, SCOT N Treasurer 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

Vice President

Name Role Address
PERKINS, RYAN S Vice President 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223
OSSI, PAUL B Vice President 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223
Stroud, Jaymeson Vice President 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000097543 ACKERMAN UROLOGY ACTIVE 2023-08-21 2028-12-31 No data 10881 SAN JOSE BOULEVARD, JACKSONVILLE, FL, 32223
G17000019042 ACKERMAN UROLOGY EXPIRED 2017-02-21 2022-12-31 No data 10881 SAN JOSE BLVD, JACKSONVILLE, FL, 32223

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2022-04-15 ACKERMAN, SACHA No data
NAME CHANGE AMENDMENT 2014-08-11 ACKERMAN CANCER CENTER, P.A. No data
REGISTERED AGENT ADDRESS CHANGED 2013-01-23 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223 No data
CHANGE OF PRINCIPAL ADDRESS 2011-01-11 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223 No data
CHANGE OF MAILING ADDRESS 2011-01-11 10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223 No data
NAME CHANGE AMENDMENT 1999-07-01 FIRST COAST ONCOLOGY, P.A. No data
NAME CHANGE AMENDMENT 1989-05-18 FIRST COAST ONCOLOGY GROUP, P.A. No data

Documents

Name Date
ANNUAL REPORT 2024-03-28
ANNUAL REPORT 2023-04-13
ANNUAL REPORT 2022-04-15
ANNUAL REPORT 2021-03-15
ANNUAL REPORT 2020-02-13
ANNUAL REPORT 2019-02-12
ANNUAL REPORT 2018-03-05
ANNUAL REPORT 2017-02-22
ANNUAL REPORT 2016-02-10
ANNUAL REPORT 2015-01-12

Related by officers

ACKERMAN, SACHA

IRIDIUM HOLDINGS, INC.

ACKERMAN, SCOT N

IRIDIUM HOLDINGS, INC. FERNANDINA CANCER CENTER, INC.

Related by address

10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

IRIDIUM HOLDINGS, INC.

10881 SAN JOSE BLVD, JACKSONVILLE, FL 32223

IRIDIUM HOLDINGS, INC.

Date of last update: 05 Feb 2025

Sources: Florida Department of State

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