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  5. ORLANDO FOOT & ANKLE CLINIC, INC.

ORLANDO FOOT & ANKLE CLINIC, INC.

Company Details

Entity Name: ORLANDO FOOT & ANKLE CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 22 Jul 1985 (40 years ago)
Date of dissolution: 22 Sep 2023 (a year ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 22 Sep 2023 (a year ago)
Document Number: H67492
FEI/EIN Number 59-2580012
Address: 3165 McCrory Place, Suite 174, ORLANDO, FL 32803
Mail Address: 3165 McCrory Place, Suite 174, ORLANDO, FL 32803
ZIP code: 32803
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1518348168 2015-06-09 2020-08-05 PO BOX 140233, ORLANDO, FL, 328140233, US 400 E HOWRY AVE, DELAND, FL, 32724, US

Contacts
Phone +1 407-423-1234

Authorized person
Name GREGORY RENTON
Role CEO
Phone 4074231234

Taxonomy
Taxonomy Code 213ES0103X - Foot & Ankle Surgery Podiatrist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 029602300
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2015 592580012 2016-10-14 ORLANDO FOOT & ANKLE CLINIC, INC. 117
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2014 592580012 2015-10-12 ORLANDO FOOT & ANKLE CLINIC, INC. 115
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2013 592580012 2014-10-10 ORLANDO FOOT & ANKLE CLINIC, INC. 110
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2012 592580012 2013-06-25 ORLANDO FOOT & ANKLE CLINIC, INC. 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012

Signature of
Role Plan administrator
Date 2013-06-25
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-25
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2011 592580012 2012-04-20 ORLANDO FOOT & ANKLE CLINIC, INC. 96
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012

Plan administrator’s name and address
Administrator’s EIN 592580012
Plan administrator’s name ORLANDO FOOT & ANKLE CLINIC, INC.
Plan administrator’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012
Administrator’s telephone number 4074231234

Signature of
Role Plan administrator
Date 2012-04-20
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-20
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2010 592580012 2011-06-06 ORLANDO FOOT & ANKLE CLINIC, INC. 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012

Plan administrator’s name and address
Administrator’s EIN 592580012
Plan administrator’s name ORLANDO FOOT & ANKLE CLINIC, INC.
Plan administrator’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 328033012
Administrator’s telephone number 4074231234

Signature of
Role Plan administrator
Date 2011-06-06
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-06
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature
ORLANDO FOOT & ANKLE CLINIC, INC. 401(K) RETIREMENT PLAN 2009 592580012 2010-08-02 ORLANDO FOOT & ANKLE CLINIC, INC. 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4074231234
Plan sponsor’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 32803

Plan administrator’s name and address
Administrator’s EIN 592580012
Plan administrator’s name ORLANDO FOOT & ANKLE CLINIC, INC.
Plan administrator’s address 3670 MAGUIRE BLVD., STE. 220, CORPORATE PARK 1, ORLANDO, FL, 32803
Administrator’s telephone number 4074231234

Signature of
Role Plan administrator
Date 2010-08-02
Name of individual signing GREGORY RENTON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NEAL, BECKY J Agent 3165 McCrory Place, Suite 174, ORLANDO, FL 32803

Vice President

Name Role Address
MOATS, DAVID B Vice President 3165 McCrory Place, Suite 174 ORLANDO, FL 32803
Shane, Amber Vice President 3165 McCrory Place, Suite 174 Orlando, FL 32803

President

Name Role Address
Childs, Douglas M President 3165 McCrory Place, Suite 174 ORLANDO, FL 32803

Secretary

Name Role Address
NEAL, Becky J Secretary 3165 McCrory Place Suite 174, Suite 174 Orlando, FL 32803

Treasurer

Name Role Address
NEAL, Becky J Treasurer 3165 McCrory Place Suite 174, Suite 174 Orlando, FL 32803

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G13000053631 PT CENTERS OF GREATER ORLANDO EXPIRED 2013-06-05 2018-12-31 No data 3670 MAGUIRE BOULEVARD, SUITE 220, ORLANDO, FL, 32803

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 No data No data
REGISTERED AGENT NAME CHANGED 2021-01-06 NEAL, BECKY J No data
REGISTERED AGENT ADDRESS CHANGED 2017-01-10 3165 McCrory Place, Suite 174, ORLANDO, FL 32803 No data
CHANGE OF PRINCIPAL ADDRESS 2017-01-10 3165 McCrory Place, Suite 174, ORLANDO, FL 32803 No data
CHANGE OF MAILING ADDRESS 2017-01-10 3165 McCrory Place, Suite 174, ORLANDO, FL 32803 No data
AMENDMENT AND NAME CHANGE 1999-08-02 ORLANDO FOOT & ANKLE CLINIC, INC. No data
SHARE EXCHANGE 1999-01-13 No data No data
NAME CHANGE AMENDMENT 1989-07-05 ORLANDO FOOT & ANKLE CLINIC, P.A. No data

Documents

Name Date
ANNUAL REPORT 2022-04-28
ANNUAL REPORT 2021-01-06
ANNUAL REPORT 2020-01-21
AMENDED ANNUAL REPORT 2019-05-20
ANNUAL REPORT 2019-01-28
ANNUAL REPORT 2018-01-12
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-01-26
ANNUAL REPORT 2015-01-12
ANNUAL REPORT 2014-01-08

Related by officers

MOATS, DAVID B

AMBULATORY ANKLE & FOOT CENTER OF FLORIDA, INC.

Related by address

No related companies by address

Date of last update: 04 Feb 2025

Sources: Florida Department of State

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