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  5. FANOURIOS I. FERDERIGOS, M.D. P.A

FANOURIOS I. FERDERIGOS, M.D. P.A

Company Details

Entity Name: FANOURIOS I. FERDERIGOS, M.D. P.A
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 24 Dec 1986 (38 years ago)
Document Number: J50050
FEI/EIN Number 592745575
Address: 2626 TAMPA ROAD, 103, PALM HARBOR, FL, 34684
Mail Address: 2626 TAMPA ROAD, 103, PALM HARBOR, FL, 34684
ZIP code: 34684
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225338510 2010-11-02 2015-06-26 2626 TAMPA RD, SUITE 103, PALM HARBOR, FL, 346843155, US 2626 TAMPA RD, SUITE 103, PALM HARBOR, FL, 346843155, US

Contacts
Phone +1 727-789-3300
Fax 7277873454

Authorized person
Name DR. FANOURIOS I. FERDERIGOS
Role PRESIDENT
Phone 7277893300

Taxonomy
Taxonomy Code 207X00000X - Orthopaedic Surgery Physician
License Number ME0040703
State FL
Is Primary Yes

Other Provider Identifiers
Issuer FEDERAL WORKERS COMP PROV
Number 220139000
State FL
Issuer MEDICARE PTAN
Number GC512A
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FANOURIOS I. FERDERIGOS, M.D., P.A. DEFINED BENEFIT PENSION PLAN 2015 592745575 2016-05-14 FANOURIOS I. FERDERIGOS, M.D., P.A. 1
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2016-05-14
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-14
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M. D. , P. A. PROFIT SHARING PLAN 2015 592745575 2016-05-14 FANOURIOS I. FERDERIGOS, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2016-05-14
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-14
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. DEFINED BENEFIT PENSION PLAN 2015 592745575 2016-05-16 FANOURIOS I. FERDERIGOS, M.D., P.A. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2016-05-16
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-16
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. DEFINED BENEFIT PENSION PLAN 2014 592745575 2015-09-20 FANOURIOS I. FERDERIGOS, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2015-09-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. PROFIT SHARING PLAN 2014 592745575 2015-09-20 FANOURIOS I. FERDERIGOS, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2015-09-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. PROFIT SHARING PLAN 2013 592745575 2014-07-23 FANOURIOS I. FERDERIGOS, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-23
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. DEFINED BENEFIT PENSION PLAN 2013 592745575 2014-07-23 FANOURIOS I. FERDERIGOS, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-23
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. PROFIT SHARING PLAN 2012 592745575 2013-08-28 FANOURIOS I. FERDERIGOS, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2013-08-28
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-28
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. DEFINED BENEFIT PENSION PLAN 2012 592745575 2013-08-28 FANOURIOS I. FERDERIGOS, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Signature of
Role Plan administrator
Date 2013-08-28
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-28
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
FANOURIOS I. FERDERIGOS, M.D., P.A. PROFIT SHARING PLAN 2011 592745575 2012-07-20 FANOURIOS I. FERDERIGOS, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277717482
Plan sponsor’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677

Plan administrator’s name and address
Administrator’s EIN 592745575
Plan administrator’s name FANOURIOS I. FERDERIGOS, M.D., P.A.
Plan administrator’s address 1344 PRESERVATION WAY, OLDSMAR, FL, 34677
Administrator’s telephone number 7277717482

Signature of
Role Plan administrator
Date 2012-07-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-20
Name of individual signing FANOURIOS FERDERIGOS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Fanourios Ferderigos MD PA Agent 2626 TAMPA ROAD, PALM HARBOR, FL, 34684

Manager

Name Role Address
FERDERIGOS FANOURIOS I Manager 2626 TAMPA RD STE 103, PALM HARBOR, FL, 34684

Director

Name Role Address
FERDERIGOS FANOURIOS I Director 2626 TAMPA RD STE 103, PALM HARBOR, FL, 34684

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 No data No data
REINSTATEMENT 2021-03-03 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
REINSTATEMENT 2010-12-08 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J13000326927 TERMINATED 1000000470000 PINELLAS 2013-01-30 2023-02-06 $ 1,925.11 STATE OF FLORIDA, DEPARTMENT OF REVENUE, CLEARWATER SERVICE CENTER, 19337 US HIGHWAY 19 N STE 200, CLEARWATER FL337643149

Related by officers

FERDERIGOS FANOURIOS I

WESTSHORE BUSINESS EXECUTIVE CENTER, LLC EXECUTIVE BUSINESS SERVICE CENTER, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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