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  5. PANAMA CITY PLASTIC SURGERY, L.L.C.

PANAMA CITY PLASTIC SURGERY, L.L.C.

Company Details

Entity Name: PANAMA CITY PLASTIC SURGERY, L.L.C.
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 May 2000 (25 years ago)
Document Number: L00000005763
FEI/EIN Number 593647683
Address: 500 AIRPORT ROAD, PANAMA CITY, FL, 32405
Mail Address: 500 AIRPORT ROAD, PANAMA CITY, FL, 32405
ZIP code: 32405
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043398621 2006-11-01 2020-08-22 500 AIRPORT RD, PANAMA CITY, FL, 324054011, US 500 AIRPORT RD, PANAMA CITY, FL, 324054011, US

Contacts
Phone +1 850-769-7270
Fax 8507697229

Authorized person
Name CHRISTINE YOUNGBLOOD
Role BILLING
Phone 8507697270

Taxonomy
Taxonomy Code 2086S0122X - Plastic and Reconstructive Surgery Physician
License Number ME67903
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS
Number 27145
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PANAMA CITY PLASTIC SURGERY PSP 2023 593647683 2024-05-21 PANAMA CITY PLASTIC SURGERY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2024-05-21
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PSP 2022 593647683 2023-06-21 PANAMA CITY PLASTIC SURGERY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2023-06-21
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PSP 2021 593647683 2022-05-13 PANAMA CITY PLASTIC SURGERY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2022-05-13
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2020 593647683 2021-03-03 PANAMA CITY PLASTIC SURGERY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2021-03-03
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2019 593647683 2020-07-08 PANAMA CITY PLASTIC SURGERY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2020-07-08
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2018 593647683 2019-07-12 PANAMA CITY PLASTIC SURGERY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2019-07-12
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2017 593647683 2018-05-25 PANAMA CITY PLASTIC SURGERY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2016 593647683 2017-03-17 PANAMA CITY PLASTIC SURGERY 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2017-03-17
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2015 593647683 2016-04-13 PANAMA CITY PLASTIC SURGERY 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2016-04-13
Name of individual signing MICHELLE MADDOX
Valid signature Filed with authorized/valid electronic signature
PANAMA CITY PLASTIC SURGERY PROFIT SHARING PLAN 2014 593647683 2015-07-21 PANAMA CITY PLASTIC SURGERY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 8507697270
Plan sponsor’s address 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2015-07-21
Name of individual signing MICHELLE BILETNIKOFF
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MOCKLER RAYMOND A Agent 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Managing Member

Name Role Address
MOCKLER RAYMOND A Managing Member 500 AIRPORT ROAD, PANAMA CITY, FL, 32405

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2003-03-05 500 AIRPORT ROAD, PANAMA CITY, FL 32405 No data
CHANGE OF MAILING ADDRESS 2003-03-05 500 AIRPORT ROAD, PANAMA CITY, FL 32405 No data
REGISTERED AGENT ADDRESS CHANGED 2003-03-05 500 AIRPORT ROAD, PANAMA CITY, FL 32405 No data

Documents

Name Date
ANNUAL REPORT 2024-02-16
ANNUAL REPORT 2023-03-10
ANNUAL REPORT 2022-03-28
ANNUAL REPORT 2021-02-26
ANNUAL REPORT 2020-03-10
ANNUAL REPORT 2019-04-19
ANNUAL REPORT 2018-04-18
ANNUAL REPORT 2017-01-26
ANNUAL REPORT 2016-04-07
ANNUAL REPORT 2015-06-02

Related by officers

MOCKLER RAYMOND A

PCPS PROPERTIES, L.L.C.

Related by address

500 AIRPORT ROAD, PANAMA CITY, FL, 32405

PCPS PROPERTIES, L.L.C.

500 AIRPORT ROAD, PANAMA CITY, FL, 32405

PCPS PROPERTIES, L.L.C.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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