Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Manatee
    4. ›
  4. 34243
    5. ›
  5. ELIZABETH F. CALLAHAN, M.D., LLC

ELIZABETH F. CALLAHAN, M.D., LLC

Company Details

Entity Name: ELIZABETH F. CALLAHAN, M.D., LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 08 Mar 2004 (21 years ago)
Document Number: L04000018081
FEI/EIN Number 20-0829594
Address: 5911 N. Honore Avenue, Suite 210, Sarasota, FL, 34243, US
Mail Address: 5911 N. Honore Avenue, Suite 210, Sarasota, FL, 34243, US
ZIP code: 34243
County: Manatee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1376576454 2006-07-09 2019-10-31 5911 N HONORE AVE, SUITE 210, SARASOTA, FL, 342432606, US 5911 N HONORE AVE, SUITE 210, SARASOTA, FL, 342432606, US

Contacts
Phone +1 941-308-7546
Fax 9413087550

Authorized person
Name MR. TOM SIDGMORE
Role PRACTICE ADMINISTRATOR
Phone 9413087546

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME89181
State FL
Is Primary Yes

Other Provider Identifiers
Issuer CLIA
Number 10D1031789
State FL
Issuer BC ID JONELLE
Number 145A6
State FL
Issuer BCBS PROVIDER NUMBER
Number 48310
State FL
Issuer BBR BCBS PROVIDER#
Number Y00CF
State FL
Issuer JONELLE'S NPI
Number 1003844937
State FL
Issuer BRR NPI
Number 1861504045
State FL
Issuer PTAN JAMIE RAISOR
Number AK933Y
State FL
Issuer JONELLE MEDICAL LICENSE
Number ME104122
State FL
Issuer NPI JAMIE RAISOR
Number 1235392424
State FL
Issuer JONELLE CIGNA PROVIDER NUMBER
Number 8188371
State FL
Issuer CP NPI
Number 1285828053
State FL
Issuer EFC NPI
Number 1477548808
State FL
Issuer GROUP BC PROVIDER NUMBER
Number 00A58
State FL
Issuer GROUP NPI
Number 1376576454
State FL
Issuer AETNA PROVIDER NUMBER
Number 7543592
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2016 200829594 2017-07-10 ELIZABETH F. CALLAHAN M.D., LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 462023154
Plan administrator’s name FIRST PARTY ADMINISTRATOR, LLC
Plan administrator’s address 5352 PEACHTREE ROAD, ATLANTA, GA, 30341
Administrator’s telephone number 8004872040

Signature of
Role Plan administrator
Date 2017-07-10
Name of individual signing JOHN A. STARR
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2015 200829594 2016-07-12 ELIZABETH F. CALLAHAN M.D., LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 462023154
Plan administrator’s name FIRST PARTY ADMINISTRATOR, LLC
Plan administrator’s address 5352 PEACHTREE ROAD, ATLANTA, GA, 30341
Administrator’s telephone number 8004872040

Signature of
Role Plan administrator
Date 2016-07-12
Name of individual signing JOHN A. STARR
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2014 200829594 2015-07-23 ELIZABETH F. CALLAHAN M.D., LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing TOM SIDGMORE
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2013 200829594 2014-07-21 ELIZABETH F. CALLAHAN M.D., LLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE, SUITE 210, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2014-07-21
Name of individual signing TOM SIDGMORE
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2012 200829594 2013-06-24 ELIZABETH F. CALLAHAN M.D., LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE, SUITE 210, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2013-06-24
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-24
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2011 200829594 2012-07-30 ELIZABETH F. CALLAHAN M.D., LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 200829594
Plan administrator’s name ELIZABETH F. CALLAHAN M.D., LLC
Plan administrator’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243
Administrator’s telephone number 9413087546

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2010 200829594 2011-10-05 ELIZABETH F. CALLAHAN M.D., LLC 14
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 200829594
Plan administrator’s name ELIZABETH F. CALLAHAN M.D., LLC
Plan administrator’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243
Administrator’s telephone number 9413087546

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with incorrect/unrecognized electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2010 200829594 2011-10-05 ELIZABETH F. CALLAHAN M.D., LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 200829594
Plan administrator’s name ELIZABETH F. CALLAHAN M.D., LLC
Plan administrator’s address 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243
Administrator’s telephone number 9413087546

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature
ELIZABETH F. CALLAHAN M.D., LLC 401(K) PROFIT SHARING PLAN 2009 200829594 2010-10-05 ELIZABETH F. CALLAHAN M.D., LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 9413087546
Plan sponsor’s address 7978 COOPER CREEK BLVD., STE. 204, BRADENTON, FL, 342010000

Plan administrator’s name and address
Administrator’s EIN 200829594
Plan administrator’s name ELIZABETH F. CALLAHAN M.D., LLC
Plan administrator’s address 7978 COOPER CREEK BLVD., STE. 204, BRADENTON, FL, 342010000
Administrator’s telephone number 9413087546

Signature of
Role Plan administrator
Date 2010-10-05
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-05
Name of individual signing RONALD A. ALLBEE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
C T CORPORATION SYSTEM Agent

Member

Name Role Address
Callahan Elizabeth FM.D. Member 4000 Hollywood Blvd, Hollywood, FL, 33021

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000059279 SKINSMART DERMATOLOGY ACTIVE 2020-05-28 2025-12-31 No data 5911 N. HONORE AVE, SUITE 210, SUITE 210, SARASOTA, FL, 34243
G12000087918 CENTER FOR SKIN SURGERY & COSMETICS EXPIRED 2012-09-07 2017-12-31 No data 5911 N. HONORE AVE., SUITE 210, SARASOTA, FL, 34243
G10000043981 SKIN SMART DERMATOLOGY EXPIRED 2010-05-19 2015-12-31 No data 7978 COOPER CREEK BLVD, SUITE 204, BRADENTON, FL, 34201
G10000043985 SKINSMART SOLUTIONS EXPIRED 2010-05-19 2015-12-31 No data 7978 COOPER CREEK BLVD, SUITE 204, BRADENTON, FL, 34201

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-03-25 5911 N. Honore Avenue, Suite 210, Sarasota, FL 34243 No data
CHANGE OF MAILING ADDRESS 2024-03-25 5911 N. Honore Avenue, Suite 210, Sarasota, FL 34243 No data
REGISTERED AGENT NAME CHANGED 2023-04-27 C T Corporation System No data
REGISTERED AGENT ADDRESS CHANGED 2023-04-27 1200 South Pine Island Road, Plantation, FL 33324 No data

Documents

Name Date
ANNUAL REPORT 2024-03-25
ANNUAL REPORT 2023-04-27
ANNUAL REPORT 2022-04-27
ANNUAL REPORT 2021-03-05
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-07
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-03-14
ANNUAL REPORT 2016-01-27
ANNUAL REPORT 2015-02-24

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated