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L TAN MD LC

Company Details

Entity Name: L TAN MD LC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 11 Dec 2003 (21 years ago)
Document Number: L03000052148
FEI/EIN Number 200474825
Address: 2915 MADISON ST, MARIANNA, FL, 32446, US
Mail Address: 2915 MADISON ST, MARIANNA, FL, 32446, US
ZIP code: 32446
County: Jackson
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346303088 2006-12-17 2020-08-22 2915 MADISON ST, MARIANNA, FL, 324463449, US 2915 MADISON ST, MARIANNA, FL, 324463449, US

Contacts

Phone +1 850-536-2460

Authorized person

Name L TAN
Role MGR
Phone 9045370954

Taxonomy

Taxonomy Code 208800000X - Urology Physician
License Number ME339964
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEK TRUST 401K PLAN 2016 200474825 2017-06-06 L TAN, MD LC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541600
Sponsor’s telephone number 8503723834
Plan sponsor’s mailing address 2915 MADISON ST, MARIANNA, FL, 324463449
Plan sponsor’s address 2915 MADISON ST, MARIANNA, FL, 324463449

Number of participants as of the end of the plan year

Active participants 2
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of

Role Plan administrator
Date 2017-06-06
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-06
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
MEK TRUST 401K PLAN 2015 200474825 2016-07-04 L TAN, MD LC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541600
Sponsor’s telephone number 7029003454
Plan sponsor’s DBA name OZONELOGICS
Plan sponsor’s address 2915 MADISON ST, MARIANNA, FL, 324463449

Signature of

Role Plan administrator
Date 2016-07-04
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-04
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
MEK TRUST 401K PLAN 2012 200474825 2013-06-11 L TAN, MD LC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541600
Sponsor’s telephone number 7029003454
Plan sponsor’s mailing address 2915 MADISON ST, MARIANNA, FL, 32446
Plan sponsor’s address 2915 MADISON ST, MARIANNA, FL, 32446

Number of participants as of the end of the plan year

Active participants 2

Signature of

Role Plan administrator
Date 2013-06-11
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-11
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature
MEK TRUST 2010 200474825 2011-07-04 L TAN MD LC 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2006-01-01
Business code 541600
Sponsor’s telephone number 8505579691
Plan sponsor’s address 2915 MADISON ST, MARIANNA, FL, 32446

Plan administrator’s name and address

Administrator’s EIN 200474825
Plan administrator’s name L TAN MD LC
Plan administrator’s address 2915 MADISON ST, MARIANNA, FL, 32446
Administrator’s telephone number 8505579691

Signature of

Role Plan administrator
Date 2011-07-04
Name of individual signing L TAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TAN L Agent 2915 MADISON ST, MARIANNA, FL, 32446

Manager

Name Role Address
TAN L Manager 2915 MADISON ST, MARIANNA, FL, 32446

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G92175000076 UROLOGY CENTER ACTIVE 1992-06-23 2027-12-31 No data 4948 FLYNT DR, UR7, MARIANNA, FL, 32446

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2008-01-21 2915 MADISON ST, MARIANNA, FL 32446 No data

Documents

Name Date
ANNUAL REPORT 2025-01-03
ANNUAL REPORT 2024-02-05
ANNUAL REPORT 2023-01-08
ANNUAL REPORT 2022-01-13
ANNUAL REPORT 2021-01-04
ANNUAL REPORT 2020-03-29
ANNUAL REPORT 2019-01-11
ANNUAL REPORT 2018-01-07
ANNUAL REPORT 2017-02-10
ANNUAL REPORT 2016-03-03

Date of last update: 02 Feb 2025

Sources: Florida Department of State