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  5. FOUR CORNERS INTERNAL MEDICINE, LLC

FOUR CORNERS INTERNAL MEDICINE, LLC

Company Details

Entity Name: FOUR CORNERS INTERNAL MEDICINE, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 08 Feb 2006 (19 years ago)
Document Number: L06000014010
FEI/EIN Number 204261617
Address: 106 POLO PARK EAST BLVD., DAVENPORT, FL, 33897, US
Mail Address: 10603 EMERALD CHASE DR., ORLANDO, FL, 32836, US
ZIP code: 33897
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346295466 2006-05-24 2010-10-20 10603 EMERALD CHASE DR, ORLANDO, FL, 328365855, US 106 POLO PARK EAST BLVD, DAVENPORT, FL, 338979407, US

Contacts
Phone +1 407-217-5353
Fax 4072175353
Phone +1 863-424-8900
Fax 8634248823

Authorized person
Name DR. SRINATH REDDY KOSANAM
Role OWNER
Phone 8634248900

Taxonomy
Taxonomy Code 261Q00000X - Clinic/Center
License Number ME78339
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FOUR CORNERS INTERNAL MEDICINE, LLC 401K PLAN 2023 204261617 2024-07-17 FOUR CORNERS INTERNAL MEDICINE LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DRIVE, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC CB PLAN 2023 204261617 2024-07-17 FOUR CORNERS INTERNAL MEDICINE, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DR, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC 401K PLAN 2022 204261617 2023-06-16 FOUR CORNERS INTERNAL MEDICINE LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DRIVE, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC CB PLAN 2022 204261617 2023-06-16 FOUR CORNERS INTERNAL MEDICINE, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DR, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC 401K PLAN 2021 204261617 2022-09-14 FOUR CORNERS INTERNAL MEDICINE LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DRIVE, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC CB PLAN 2021 204261617 2022-09-14 FOUR CORNERS INTERNAL MEDICINE, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DR, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC CB PLAN 2020 204261617 2021-06-14 FOUR CORNERS INTERNAL MEDICINE, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DR, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC 401K PLAN 2020 204261617 2021-06-14 FOUR CORNERS INTERNAL MEDICINE LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DRIVE, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC 401K PLAN 2019 204261617 2020-04-21 FOUR CORNERS INTERNAL MEDICINE LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DRIVE, ORLANDO, FL, 32836
FOUR CORNERS INTERNAL MEDICINE, LLC CB PLAN 2019 204261617 2020-06-18 FOUR CORNERS INTERNAL MEDICINE, LLC 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4072175353
Plan sponsor’s address 10603 EMERALD CHASE DR, ORLANDO, FL, 32836

Agent

Name Role Address
KOSANAM SRINATH REDDY O Agent 10603 EMERALD CHASE DR., ORLANDO, FL, 32836

Managing Member

Name Role Address
KOSANAM SRINATH REDDY M Managing Member 10603 EMERALD CHASE DR., ORLANDO, FL, 32836

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2010-01-06 106 POLO PARK EAST BLVD., DAVENPORT, FL 33897 No data
CHANGE OF MAILING ADDRESS 2010-01-06 106 POLO PARK EAST BLVD., DAVENPORT, FL 33897 No data
REGISTERED AGENT ADDRESS CHANGED 2010-01-06 10603 EMERALD CHASE DR., ORLANDO, FL 32836 No data
REGISTERED AGENT NAME CHANGED 2007-01-26 KOSANAM, SRINATH REDDY OFFICER No data

Documents

Name Date
ANNUAL REPORT 2025-01-10
ANNUAL REPORT 2024-01-17
ANNUAL REPORT 2023-01-22
ANNUAL REPORT 2022-01-22
ANNUAL REPORT 2021-01-09
ANNUAL REPORT 2020-01-14
ANNUAL REPORT 2019-01-28
ANNUAL REPORT 2018-01-11
ANNUAL REPORT 2017-01-07
ANNUAL REPORT 2016-01-22

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

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