| Entity Name: | LAKE COUNTY ANESTHESIA ASSOCIATES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Dec 2003 (21 years ago) |
| Document Number: | L03000052206 |
| FEI/EIN Number | 200494012 |
| Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| Mail Address: | 150 SE 17th St., #503, OCALA, FL, 34471, US |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285679894 | 2006-06-18 | 2007-11-30 | PO BOX 3130, OCALA, FL, 344783130, US | 1511 SW 1ST AVE, OCALA, FL, 344716505, US | |||||||||||||||||||||
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| Phone | +1 352-867-0516 |
| Fax | 3528675076 |
Authorized person
| Name | VINCENT C. PALMIRE JR. |
| Role | PARTNER |
| Phone | 3528678311 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS FL |
| Number | 74504 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE COUNTY ANESTHESIA ASSOCIATES PLLC RETIREMENT SAVINGS PLAN | 2012 | 200494012 | 2013-09-04 | LAKE COUNTY ANESTHESIA ASSOCIATES PLLC | 16 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-09-04 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-09-04 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3528678311 |
| Plan sponsor’s address | 1511 SW 1ST AVE, OCALA, FL, 34471 |
Plan administrator’s name and address
| Administrator’s EIN | 200494012 |
| Plan administrator’s name | LAKE COUNTY ANESTHESIA ASSOCIATES PLLC |
| Plan administrator’s address | 1511 SW 1ST AVE, OCALA, FL, 34471 |
| Administrator’s telephone number | 3528678311 |
Signature of
| Role | Plan administrator |
| Date | 2012-08-02 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-08-02 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3528678311 |
| Plan sponsor’s address | 1511 SW 1ST AVENUE, OCALA, FL, 34471 |
Plan administrator’s name and address
| Administrator’s EIN | 200494012 |
| Plan administrator’s name | LAKE COUNTY ANESTHESIA ASSOCIATES PLLC |
| Plan administrator’s address | 1511 SW 1ST AVENUE, OCALA, FL, 34471 |
| Administrator’s telephone number | 3528678311 |
Signature of
| Role | Plan administrator |
| Date | 2011-09-08 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-09-08 |
| Name of individual signing | FAY STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3528678311 |
| Plan sponsor’s address | 1511 SW 1ST AVENUE, OCALA, FL, 344716505 |
Plan administrator’s name and address
| Administrator’s EIN | 200494012 |
| Plan administrator’s name | LAKE COUNTY ANESTHESIA ASSOCIATES, PLLC |
| Plan administrator’s address | 1511 SW 1ST AVENUE, OCALA, FL, 344716505 |
| Administrator’s telephone number | 3528678311 |
Signature of
| Role | Plan administrator |
| Date | 2010-05-10 |
| Name of individual signing | FRANCES STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-05-10 |
| Name of individual signing | FRANCES STOCKMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| CHESTNUT BUSINESS SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PALMIRE VINCENT M | Manager | 150 SE 17th St., OCALA, FL, 34471 |
| CARDIOVASCULAR ANESTHESIA CONSULTANTS | Manager | 150 SE 17th St., OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-03-09 | Chestnut Business Services LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-09 | 401 E Jackson St Suite 3100, Tampa,, FL 33602 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-06 | 150 SE 17th St., #503, OCALA, FL 34471 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-06 | 150 SE 17th St., #503, OCALA, FL 34471 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-03-10 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-04-11 |
| ANNUAL REPORT | 2020-04-08 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
