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  5. THOMAS E. CARSON, M.D., P.A.

THOMAS E. CARSON, M.D., P.A.

Company Details

Entity Name: THOMAS E. CARSON, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 01 Dec 1983 (41 years ago)
Date of dissolution: 03 Jan 2024 (a year ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 03 Jan 2024 (a year ago)
Document Number: G72293
FEI/EIN Number 59-2341946
Address: 1114 S. Florida Ave., Tarpon Spring, FL 34689
Mail Address: 1114 S. Florida Ave., Tarpon Spring, FL 34689
ZIP code: 34689
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043236565 2006-07-15 2018-02-26 1259 S PINELLAS AVE, TARPON SPRINGS, FL, 346893719, US 1259 S PINELLAS AVE, TARPON SPRINGS, FL, 346893719, US

Contacts
Phone +1 727-938-1908
Fax 7279388693

Authorized person
Name DR. THOMAS EDWARD CARSON
Role OWNER/PHYSICIAN
Phone 7279381908

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME36578
State FL
Is Primary Yes
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number OS9655
State FL
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME108731
State FL
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME110547
State FL
Is Primary No
Taxonomy Code 363A00000X - Physician Assistant
License Number PA9105368
State FL
Is Primary No
Taxonomy Code 363L00000X - Nurse Practitioner
License Number ARNP1658442
State FL
Is Primary No
Taxonomy Code 363L00000X - Nurse Practitioner
License Number ARNP3391502
State FL
Is Primary No
Taxonomy Code 363LF0000X - Family Nurse Practitioner
License Number ARNP3391502
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 004037600
State FL
Issuer NPI GROUP NUMBER
Number 1043236565
State FL
Issuer NPI NUMBER
Number 1962733261
State FL
Issuer NPI NUMBER
Number 1316337769
State FL
Issuer NPI NUMBER
Number 1427058791
State FL
Issuer NPI NUMBER
Number 1376544049
State FL
Issuer NPI NUMBER
Number 1417114737
State FL
Issuer MEDICAID
Number 002575201
State FL
Issuer MEDICAID
Number 039716400
State FL
Issuer NPI
Number 1053624221
State FL
Issuer MEDICAID
Number 274337000
State FL
Issuer NPI NUMBER
Number 1154313997
State FL
Issuer MEDICAID
Number 002575200
State FL
Issuer MEDICAID
Number 004107200
State FL
Issuer MEDICAID
Number 005549700
State FL
Issuer NPI GROUP NUMBER TRINITY
Number 1487926861
State FL
Issuer MEDICAID
Number 304782201
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 592341946 2023-06-28 THOMAS E. CARSON, M.D., P.A. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1114 SOUTH FLORIDA AVENUE, TARPON SPRINGS, FL, 34689
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2021 592341946 2022-03-25 THOMAS E. CARSON, M.D., P.A. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1114 SOUTH FLORIDA AVENUE, TARPON SPRINGS, FL, 34689
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2020 592341946 2021-04-26 THOMAS E. CARSON, M.D., P.A. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2019 592341946 2020-09-14 THOMAS E. CARSON, M.D., P.A. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2018 592341946 2019-10-01 THOMAS E. CARSON, M.D., P.A. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2017 592341946 2018-09-27 THOMAS E. CARSON, M.D., P.A. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2016 592341946 2017-08-24 THOMAS E. CARSON, M.D., P.A. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719

Signature of
Role Plan administrator
Date 2017-08-24
Name of individual signing THOMAS E. CARSON
Valid signature Filed with authorized/valid electronic signature
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2015 592341946 2016-09-20 THOMAS E. CARSON, M.D., P.A. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719

Signature of
Role Plan administrator
Date 2016-09-20
Name of individual signing THOMAS E. CARSON
Valid signature Filed with authorized/valid electronic signature
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2014 592341946 2015-09-08 THOMAS E. CARSON, M.D., P.A. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719

Signature of
Role Plan administrator
Date 2015-09-08
Name of individual signing THOMAS E. CARSON
Valid signature Filed with authorized/valid electronic signature
THOMAS E. CARSON, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2013 592341946 2014-08-07 THOMAS E. CARSON, M.D., P.A. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-12-01
Business code 621111
Sponsor’s telephone number 7279381908
Plan sponsor’s address 1259 SOUTH PINELLAS AVENUE, TARPON SPRINGS, FL, 346893719

Signature of
Role Plan administrator
Date 2014-08-07
Name of individual signing THOMAS E. CARSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CARSON, THOMAS E Agent 1114 S. Florida Ave., Tarpon Spring, FL 34689

President

Name Role Address
CARSON, THOMAS E President 1114 S. Florida Ave., Tarpon Spring, FL 34689

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2024-01-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2021-04-11 1114 S. Florida Ave., Tarpon Spring, FL 34689 No data
CHANGE OF MAILING ADDRESS 2021-04-11 1114 S. Florida Ave., Tarpon Spring, FL 34689 No data
REGISTERED AGENT ADDRESS CHANGED 2021-04-11 1114 S. Florida Ave., Tarpon Spring, FL 34689 No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J24000629152 TERMINATED 1000001013602 PINELLAS 2024-09-18 2034-09-25 $ 517.50 STATE OF FLORIDA, DEPARTMENT OF REVENUE, LARGO SERVICE CENTER, 11351 ULMERTON RD STE 220, LARGO FL337781629

Documents

Name Date
VOLUNTARY DISSOLUTION 2024-01-03
ANNUAL REPORT 2023-04-04
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-04-11
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-25
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-26
ANNUAL REPORT 2016-01-25
ANNUAL REPORT 2015-01-12

Related by officers

CARSON, THOMAS E

ACCESS GRAPHICS, INC.

Related by address

No related companies by address

Date of last update: 05 Feb 2025

Sources: Florida Department of State

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