| Entity Name: | M.W. KILGORE II, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
M.W. KILGORE II, M.D., P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 16 Dec 1983 (41 years ago) |
| Date of dissolution: | 27 Sep 2019 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (6 years ago) |
| Document Number: | G74340 |
| FEI/EIN Number |
592371899
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| Mail Address: | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223, US |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821284589 | 2007-09-17 | 2009-11-04 | 11363 SAN JOSE BLVD, SUITE 102, JACKSONVILLE, FL, 322237957, US | 11363 SAN JOSE BLVD, SUITE 102, JACKSONVILLE, FL, 322237957, US | |||||||||||||||||||||||||
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| Phone | +1 904-396-2400 |
| Fax | 9043963750 |
Authorized person
| Name | DR. MANLEY W KILGORE II |
| Role | PHYSICIAN |
| Phone | 9043962400 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME17133 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 059854200 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| M.W. KILGORE, II M.D., P.A. RETIREMENT PLAN AND TRUST | 2010 | 593207150 | 2011-10-12 | M.W. KILGORE, II M.D., P.A. | 19 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 593207150 |
| Plan administrator’s name | M.W. KILGORE, II M.D., P.A. |
| Plan administrator’s address | 11363 SAN JOSE BLVD., SUITE 102, JACKSONVILLE, FL, 32223 |
| Administrator’s telephone number | 9043962400 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-12 |
| Name of individual signing | M.W. KILGORE, II |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1992-07-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9043962400 |
| Plan sponsor’s address | 836 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 322078343 |
Plan administrator’s name and address
| Administrator’s EIN | 593207150 |
| Plan administrator’s name | M.W. KILGORE, II. M.D., P.A. |
| Plan administrator’s address | 836 PRUDENTIAL DRIVE, SUITE 1601, JACKSONVILLE, FL, 322078343 |
| Administrator’s telephone number | 9043962400 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-23 |
| Name of individual signing | LESLIE A. O'BRYAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| KILGORE, II, M.D. M. W | President | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| KILGORE, II, M.D. M. W | Secretary | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| KILGORE, II, M.D. M. W | Treasurer | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| KILGORE, II, M.D. M. W | Director | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| KILGORE, II M W | Agent | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL, 32223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | - | - |
| CHANGE OF MAILING ADDRESS | 2017-03-31 | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL 32223 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-27 | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL 32223 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-03-27 | 12904 BAY PLANTATION DRIVE, JACKSONVILLE, FL 32223 | - |
| REGISTERED AGENT NAME CHANGED | 2009-04-23 | KILGORE, II, M W | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-02-27 |
| ANNUAL REPORT | 2017-03-31 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-01 |
| AMENDED ANNUAL REPORT | 2014-04-29 |
| ANNUAL REPORT | 2014-04-03 |
| ANNUAL REPORT | 2013-02-12 |
| ANNUAL REPORT | 2012-03-27 |
| ANNUAL REPORT | 2011-03-04 |
| ADDRESS CHANGE | 2010-05-06 |
Date of last update: 01 May 2025
Sources: Florida Department of State
