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  5. MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.

MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.

Company Details

Entity Name: MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 29 Jul 1982 (43 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 30 Sep 1991 (33 years ago)
Document Number: F93486
FEI/EIN Number 59-2206347
Address: 311 N MANGOUSTINE AVENUE, SANFORD, FL 32771
Mail Address: 311 N MANGOUSTINE AVENUE, SANFORD, FL 32771
ZIP code: 32771
County: Seminole
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1841474103 2007-12-21 2010-09-20 311 N MANGOUSTINE AVE, SANFORD, FL, 327711098, US 311 N MANGOUSTINE AVE, SANFORD, FL, 327711098, US

Contacts
Phone +1 407-321-4570
Fax 4073217690

Authorized person
Name DR. LENKALA REDDY MALLAIAH
Role PRESIDENT
Phone 4073214570

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME0037029
State FL
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MEDICARE
Number 110047015
State FL
Issuer MEDICARE
Number 77496
Issuer RAILROAD MEDICARE
Number CB7606
State FL
Issuer MEDICAID
Number 065414100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2016 592206347 2017-07-18 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2016 592206347 2017-07-18 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 6
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2016 592206347 2017-07-18 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2015 592206347 2016-10-05 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2014 592206347 2015-07-09 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771

Signature of
Role Plan administrator
Date 2015-07-09
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2013 592206347 2014-09-17 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771

Signature of
Role Plan administrator
Date 2014-09-17
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2012 592206347 2013-07-17 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771

Plan administrator’s name and address
Administrator’s EIN 592206347
Plan administrator’s name MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.
Plan administrator’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
Administrator’s telephone number 4073214570

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2011 592206347 2012-10-11 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771

Plan administrator’s name and address
Administrator’s EIN 592206347
Plan administrator’s name MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.
Plan administrator’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
Administrator’s telephone number 4073214570

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
MID-FLORIDA GASTROENTEROLOGY GROUP 401(K) PROFIT SHARING PLAN AND TRUST 2010 592206347 2011-05-26 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771

Plan administrator’s name and address
Administrator’s EIN 592206347
Plan administrator’s name MID-FLORIDA GASTROENTEROLOGY GROUP, P.A.
Plan administrator’s address 311 N. MANGOUSTINE AVENUE, UNIT D, SANFORD, FL, 32771
Administrator’s telephone number 4073214570

Signature of
Role Plan administrator
Date 2011-05-26
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
MID-FLORIDA GASTROENTEROLOGY GROUP 401K PROFIT SHARING PLAN & TRUST 2009 592206347 2010-10-05 MID-FLORIDA GASTROENTEROLOGY GROUP P.A. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4073214570
Plan sponsor’s address 311 N. MANGOUSTINE AVE, SANFORD, FL, 32771

Plan administrator’s name and address
Administrator’s EIN 592206347
Plan administrator’s name MID-FLORIDA GASTROENTEROLOGY GROUP P.A.
Plan administrator’s address 311 N. MANGOUSTINE AVE, SANFORD, FL, 32771
Administrator’s telephone number 4073214570

Signature of
Role Plan administrator
Date 2010-10-05
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-05
Name of individual signing LENKALA MALLAIAH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MALLAIAH MD, LENKALA R Agent 311 NORTH MANGOUSTINE AVENUE, SANFORD, FL 32771

Secretary

Name Role Address
Mallaiah, Cheryl Secretary 311 N MANGOUSTINE AVENUE, SANFORD, FL 32771

President

Name Role Address
MALLAIAH, LENKALA R. President 311 NORTH MANGOUSTINE AVENUE, SANFORD, FL

Treasurer

Name Role Address
MALLAIAH, LENKALA R. Treasurer 311 NORTH MANGOUSTINE AVENUE, SANFORD, FL

Director

Name Role Address
MALLAIAH, LENKALA R. Director 311 NORTH MANGOUSTINE AVENUE, SANFORD, FL

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2009-04-27 311 N MANGOUSTINE AVENUE, SANFORD, FL 32771 No data
CHANGE OF MAILING ADDRESS 2009-04-27 311 N MANGOUSTINE AVENUE, SANFORD, FL 32771 No data
REGISTERED AGENT ADDRESS CHANGED 1999-03-30 311 NORTH MANGOUSTINE AVENUE, SANFORD, FL 32771 No data
NAME CHANGE AMENDMENT 1991-09-30 MID-FLORIDA GASTROENTEROLOGY GROUP, P.A. No data

Documents

Name Date
ANNUAL REPORT 2024-03-28
ANNUAL REPORT 2023-04-20
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-04-20
ANNUAL REPORT 2020-05-26
ANNUAL REPORT 2019-04-24
ANNUAL REPORT 2018-04-25
ANNUAL REPORT 2017-04-10
ANNUAL REPORT 2016-04-27
ANNUAL REPORT 2015-04-23

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 05 Feb 2025

Sources: Florida Department of State

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