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  5. ANESTHESIA OF INDIAN RIVER, INC.

ANESTHESIA OF INDIAN RIVER, INC.

Company Details

Entity Name: ANESTHESIA OF INDIAN RIVER, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 16 Dec 1987 (37 years ago)
Date of dissolution: 25 Sep 2020 (4 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2020 (4 years ago)
Document Number: K07410
FEI/EIN Number 65-0037808
Address: 1555 INDIAN RIVER BLVD, SUITE B120, VERO BEACH, FL 32960
Mail Address: 1555 INDIAN RIVER BLVD, SUITE B120, VERO BEACH, FL 32960
ZIP code: 32960
County: Indian River
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1750892121 2017-10-12 2017-10-12 873 RYANWOOD DR, WEST PALM BEACH, FL, 334131138, US 1000 36TH ST, VERO BEACH, FL, 329604862, US

Contacts
Phone +1 561-632-4239
Phone +1 772-567-4311

Authorized person
Name DR. DONALD PORTELL
Role ANESTHESIOLOGIST
Phone 7727789621

Taxonomy
Taxonomy Code 367H00000X - Anesthesiologist Assistant
License Number AA425
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANESTHESIA OF INDIAN RIVER INC. PROFIT SHARING PLAN 2020 650037808 2021-03-08 ANESTHESIA OF INDIAN RIVER INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 650037808
Plan administrator’s name ANESTHESIA OF INDIAN RIVER INC.
Plan administrator’s address 1575 INDIAN RIVER BLVD., STE. C-240, VERO BEACH, FL, 32960
Administrator’s telephone number 7727789621
ANESTHESIA OF INDIAN RIVER, INC. CASH BALANCE DEFINED BENEFIT PLAN 2019 650037808 2020-07-20 ANESTHESIA OF INDIAN RIVER INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1575 INDIAN RIVER BLVD, SUITE C240, VERO BEACH, FL, 32960
ANESTHESIA OF INDIAN RIVER, INC. CASH BALANCE DEFINED BENEFIT PLAN 2019 650037808 2020-12-08 ANESTHESIA OF INDIAN RIVER INC. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1575 INDIAN RIVER BLVD, SUITE C240, VERO BEACH, FL, 32960
ANESTHESIA OF INDIAN RIVER INC. PROFIT SHARING PLAN 2019 650037808 2020-07-17 ANESTHESIA OF INDIAN RIVER INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 650037808
Plan administrator’s name ANESTHESIA OF INDIAN RIVER INC.
Plan administrator’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
Administrator’s telephone number 7727789621
ANESTHESIA OF INDIAN RIVER INC. PROFIT SHARING PLAN 2018 650037808 2019-08-08 ANESTHESIA OF INDIAN RIVER INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 650037808
Plan administrator’s name ANESTHESIA OF INDIAN RIVER INC.
Plan administrator’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
Administrator’s telephone number 7727789621
ANESTHESIA OF INDIAN RIVER, INC. CASH BALANCE DEFINED BENEFIT PLAN 2018 650037808 2019-08-13 ANESTHESIA OF INDIAN RIVER INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
ANESTHESIA OF INDIAN RIVER, INC. CASH BALANCE DEFINED BENEFIT PLAN 2017 650037808 2018-03-02 ANESTHESIA OF INDIAN RIVER INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
ANESTHESIA OF INDIAN RIVER INC. PROFIT SHARING PLAN 2017 650037808 2018-03-02 ANESTHESIA OF INDIAN RIVER INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 650037808
Plan administrator’s name ANESTHESIA OF INDIAN RIVER INC.
Plan administrator’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
Administrator’s telephone number 7727789621
ANESTHESIA OF INDIAN RIVER INC. PROFIT SHARING PLAN 2016 650037808 2017-10-16 ANESTHESIA OF INDIAN RIVER INC. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 650037808
Plan administrator’s name ANESTHESIA OF INDIAN RIVER INC.
Plan administrator’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960
Administrator’s telephone number 7727789621
ANESTHESIA OF INDIAN RIVER, INC. CASH BALANCE DEFINED BENEFIT PLAN 2016 650037808 2017-10-16 ANESTHESIA OF INDIAN RIVER INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7727789621
Plan sponsor’s address 1555 INDIAN RIVER BLVD., STE. B-120, VERO BEACH, FL, 32960

Agent

Name Role Address
Jarvis, Michele Agent 1555 INDIAN RIVER BLVD, SUITE B-120, VERO BEACH, FL 32960

Vice President

Name Role Address
RICHARDSON, MARION L.,MD Vice President 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960

Director

Name Role Address
RICHARDSON, MARION L.,MD Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960
PORTELL, DONALD J, DO Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960
MONUSZKO, EILEEN A, MD Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960
NYE, PHILLIP A, MD Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960
WHEELEY, MARTHA L, MD Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960
WOLF, GEOFFREY B, MD Director 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960

President

Name Role Address
PORTELL, DONALD J, DO President 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960

Secretary

Name Role Address
MONUSZKO, EILEEN A, MD Secretary 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960

Treasurer

Name Role Address
WOLF, GEOFFREY B, MD Treasurer 1555 INDIAN RIVER BLVD, SUITE B120 VERO BEACH, FL 32960

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
REGISTERED AGENT ADDRESS CHANGED 2017-03-02 1555 INDIAN RIVER BLVD, SUITE B-120, VERO BEACH, FL 32960 No data
REGISTERED AGENT NAME CHANGED 2015-02-01 Jarvis, Michele No data
CHANGE OF PRINCIPAL ADDRESS 2014-03-25 1555 INDIAN RIVER BLVD, SUITE B120, VERO BEACH, FL 32960 No data
CHANGE OF MAILING ADDRESS 2014-03-25 1555 INDIAN RIVER BLVD, SUITE B120, VERO BEACH, FL 32960 No data
NAME CHANGE AMENDMENT 1992-06-10 ANESTHESIA OF INDIAN RIVER, INC. No data
REINSTATEMENT 1989-02-10 No data No data
INVOLUNTARILY DISSOLVED 1988-11-04 No data No data

Documents

Name Date
ANNUAL REPORT 2019-03-04
ANNUAL REPORT 2018-02-08
ANNUAL REPORT 2017-03-02
ANNUAL REPORT 2016-03-04
ANNUAL REPORT 2015-02-01
ANNUAL REPORT 2014-03-25
ANNUAL REPORT 2013-02-28
ANNUAL REPORT 2012-03-27
ANNUAL REPORT 2011-04-13
ANNUAL REPORT 2010-03-31

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 04 Feb 2025

Sources: Florida Department of State

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