Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. St. Johns
    4. ›
  4. 32080
    5. ›
  5. ANCIENT CITY PEDIATRICS, LLC

ANCIENT CITY PEDIATRICS, LLC

Company Details

Entity Name: ANCIENT CITY PEDIATRICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 26 Oct 2005 (19 years ago)
Last Event: AMENDMENT
Event Date Filed: 19 Dec 2005 (19 years ago)
Document Number: L05000105126
FEI/EIN Number 593544464
Address: 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080
Mail Address: 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1053598292 2008-01-30 2024-10-23 1301 PLANTATION ISLAND DR S STE 104, SAINT AUGUSTINE, FL, 320803108, US 1301 PLANTATION ISLAND DR S STE 104, SAINT AUGUSTINE, FL, 320803108, US

Contacts
Phone +1 904-461-1560
Fax 9044614304

Authorized person
Name ADRIENNE MCCOY
Role OFFICE MANAGER
Phone 9044611560

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2023 592951584 2024-07-16 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2022 592951584 2023-06-20 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2023-06-20
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2021 592951584 2022-05-31 ANCIENT CITY PEDIATRICS 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2022-05-31
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2020 592951584 2021-07-15 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2019 592951584 2020-03-24 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2020-03-24
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2018 592951584 2019-05-14 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2019-05-14
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2017 592951584 2018-07-26 ANCIENT CITY PEDIATRICS 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2016 592951584 2017-07-25 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-25
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2015 592951584 2016-09-07 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2016-09-07
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-07
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2014 592951584 2015-07-29 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing MIGUEL MAS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-29
Name of individual signing MIGUEL MAS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MCLEOD ROBERT L Agent 1200 PLANTATION ISLAND DRIVE SOUTH, ST. AUGUSTINE, FL, 32080

Managing Member

Name Role Address
MAS MIGUEL A Managing Member 1301 PLANTATION ISLAND DRIVE SOUTH, #404, ST. AUGUSTINE, FL, 32084

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2010-02-15 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL 32080 No data
AMENDMENT 2005-12-19 No data No data

Documents

Name Date
ANNUAL REPORT 2024-03-18
ANNUAL REPORT 2023-02-23
ANNUAL REPORT 2022-03-12
ANNUAL REPORT 2021-03-13
ANNUAL REPORT 2020-03-19
ANNUAL REPORT 2019-03-13
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-02-03
ANNUAL REPORT 2016-02-29
ANNUAL REPORT 2015-02-22

Related by officers

MAS MIGUEL A

MAS PEDIATRICS, P.A. MAS PROPERTIES, LLC

MCLEOD ROBERT L

EAGLE LINES TRUCKING INC KRESMAC, LLC AUGSPAN, LLC RSM TRUST INTERESTS, LLC ROBLES 56, LLC C.R. FITNESS, INC. LESMAC, LLC BILL GOODE'S CUSTOM CABINETS, INC. NORTHSTAR GROUP, L.L.C. MCLEOD.CANAN.LLC

Related by address

1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080

HEMANT K. BHARGAVA, M.D., P.A.

1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080

HEMANT K. BHARGAVA, M.D., P.A.

Date of last update: 02 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