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  5. CAROLINE C. HONCULADA M.D., LLC

CAROLINE C. HONCULADA M.D., LLC

Company Details

Entity Name: CAROLINE C. HONCULADA M.D., LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 23 Mar 2006 (19 years ago)
Date of dissolution: 02 Oct 2019 (5 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 02 Oct 2019 (5 years ago)
Document Number: L06000030719
FEI/EIN Number 593658317
Address: 425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL, 33853
Mail Address: 425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL, 33853
ZIP code: 33853
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1639314354 2008-12-09 2012-06-20 425 S 11TH ST, SUITE 1, LAKE WALES, FL, 338534239, US 425 S 11TH ST, SUITE 1, LAKE WALES, FL, 338534342, US

Contacts
Phone +1 863-679-9494
Fax 8636798866

Authorized person
Name DR. CAROLINE C HONCULADA
Role OWNER
Phone 8636799494

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
License Number ME0073068
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 255077600
State FL
Issuer BCBS
Number 43859
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2018 593658317 2019-07-19 CAROLINE C. HONCULADA, M.D., LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2017 593658317 2018-10-03 CAROLINE C. HONCULADA, M.D., LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2016 593658317 2017-09-19 CAROLINE C. HONCULADA, M.D., LLC 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2017-09-19
Name of individual signing CAROLINE C. HONCULADA, M.D.
Valid signature Filed with authorized/valid electronic signature
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2015 593658317 2016-10-11 CAROLINE C. HONCULADA, M.D., LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing CAROLINE C. HONCULADA, M.D.
Valid signature Filed with authorized/valid electronic signature
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2014 593658317 2015-10-05 CAROLINE C. HONCULADA, M.D., LLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing CAROLINE C. HONCULADA, M.D.
Valid signature Filed with authorized/valid electronic signature
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. CASH BALANCE PLAN 2013 593658317 2014-09-16 CAROLINE C. HONCULADA, M.D., LLC 0
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2014-09-16
Name of individual signing CAROLINE C. HONCULADA, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HONCULADA CAROLINE C Agent 425 S. ELEVENTH ST., LAKE WALES, FL, 33853

President

Name Role Address
HONCULADA CAROLINE CDr. President 425 S. ELEVENTH ST. SUITE 1, LAKE WALES, FL, 33853

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2019-10-02 No data No data
REGISTERED AGENT ADDRESS CHANGED 2013-01-31 425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL 33853 No data
CHANGE OF PRINCIPAL ADDRESS 2011-01-13 425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL 33853 No data
CHANGE OF MAILING ADDRESS 2011-01-13 425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL 33853 No data
LC AMENDED AND RESTATED ARTICLES 2006-07-17 No data No data
CONVERSION 2006-03-23 No data CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P00000064481. CONVERSION NUMBER 300000056173

Documents

Name Date
VOLUNTARY DISSOLUTION 2019-10-02
ANNUAL REPORT 2019-02-14
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-01-21
ANNUAL REPORT 2015-01-29
ANNUAL REPORT 2014-02-26
ANNUAL REPORT 2013-01-31
ANNUAL REPORT 2012-02-07
ANNUAL REPORT 2011-01-13

Related by officers

HONCULADA CAROLINE C

PHYSICIAN BILLING AND ADVANCED SOLUTIONS LLC MASTERPIECE, LLC PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC CAROLINE C. HONCULADA M.D., P.A. EAGLE POND, LLC CEBU INVESTMENTS, LLC ENCLAVE CYPRESSWOOD, LLC EAST CENTRAL AVENUE, LLC LAKE WALES LINDEN LANE, LLC

Related by address

425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL, 33853

PHYSICIAN BILLING AND ADVANCED SOLUTIONS LLC

425 S. ELEVENTH ST., SUITE 1, LAKE WALES, FL, 33853

PHYSICIAN BILLING AND ADVANCED SOLUTIONS LLC

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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