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  5. JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.

JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.

Company Details

Entity Name: JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 04 Jan 1988 (37 years ago)
Document Number: K10796
FEI/EIN Number 592861820
Address: 8774 PERIMETER PARK BLVD, JACKSONVILLE, FL, 32216, US
Mail Address: 851 CHICOPIT LN, JACKSONVILLE, FL, 32225, US
ZIP code: 32216
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1417955196 2005-07-07 2012-01-13 8774 PERIMETER PARK BLVD, JACKSONVILLE, FL, 322166347, US 8774 PERIMETER PARK BLVD, JACKSONVILLE, FL, 322166347, US

Contacts
Phone +1 904-642-6100
Fax 9046425154

Authorized person
Name DR. ENRIQUE MANUEL SILVA
Role PRESIDENT
Phone 9046426100

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number ME0044830
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 375327102
State FL
Issuer MEDICAID
Number 375327101
State FL
Issuer MEDICAID
Number 375327100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. PROFIT SHARING PLAN 2014 592861820 2015-02-13 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. PROFIT SHARING PLAN 2014 592861820 2015-07-14 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. PROFIT SHARING PLAN 2013 592861820 2014-04-17 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D. P.A. PROFIT SHARING PLAN 2012 592861820 2013-04-10 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Plan administrator’s name and address
Administrator’s EIN 592861820
Plan administrator’s name JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
Plan administrator’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
Administrator’s telephone number 9043546868

Signature of
Role Plan administrator
Date 2013-04-10
Name of individual signing BARBARA B. SILVA
Valid signature Filed with authorized/valid electronic signature
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D. P.A. PROFIT SHARING PLAN 2011 592861820 2012-03-30 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Plan administrator’s name and address
Administrator’s EIN 592861820
Plan administrator’s name JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
Plan administrator’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
Administrator’s telephone number 9043546868

Signature of
Role Plan administrator
Date 2012-03-30
Name of individual signing BARBARA B. SILVA
Valid signature Filed with authorized/valid electronic signature
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D. P.A. PROFIT SHARING PLAN 2010 592861820 2011-04-11 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Plan administrator’s name and address
Administrator’s EIN 592861820
Plan administrator’s name JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
Plan administrator’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
Administrator’s telephone number 9043546868

Signature of
Role Plan administrator
Date 2011-04-11
Name of individual signing BARBARA B. SILVA
Valid signature Filed with authorized/valid electronic signature
JACKSONVILLE PEDIATRIC ASSOCIATES, M.D. P.A. PROFIT SHARING PLAN 2009 592861820 2010-07-06 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 9043546868
Plan sponsor’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Plan administrator’s name and address
Administrator’s EIN 592861820
Plan administrator’s name JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
Plan administrator’s address 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
Administrator’s telephone number 9043546868

Signature of
Role Plan administrator
Date 2010-07-06
Name of individual signing BARBARA B. SILVA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Simmons Sidney Agent 1050 Riverside Avenue, JACKSONVILLE, FL, 32204

President

Name Role Address
SILVA ENRIQUE M President 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Director

Name Role Address
SILVA ENRIQUE M Director 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225
ROMEU ALFREDO M Director 9026 HECHSCHER DR, JACKSONVILLE, FL, 32226
QUINTANA J C Director 2297 OCEANSIDE CT, ATLANTIC BEACH, FL, 32233
SILVA BARBARA B Director 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Vice President

Name Role Address
ROMEU ALFREDO M Vice President 9026 HECHSCHER DR, JACKSONVILLE, FL, 32226

Secretary

Name Role Address
QUINTANA J C Secretary 2297 OCEANSIDE CT, ATLANTIC BEACH, FL, 32233

Treasurer

Name Role Address
SILVA BARBARA B Treasurer 851 CHICOPIT LANE, JACKSONVILLE, FL, 32225

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
NAME CHANGE AMENDMENT 1990-04-13 JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A. No data

Related by officers

SILVA ENRIQUE M

XAVIERS & ASSOCIATES INC KIDS COMPREHENSIVE MEDICAL CARE, INC.

Simmons Sidney

CUBICHE, INC.

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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