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  5. ONE SOURCE MEDICAL GROUP, LLC

ONE SOURCE MEDICAL GROUP, LLC

Company Details

Entity Name: ONE SOURCE MEDICAL GROUP, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 May 2007 (18 years ago)
Last Event: LC STMNT OF RA/RO CHG
Event Date Filed: 05 Jun 2017 (8 years ago)
Document Number: L07000053246
FEI/EIN Number 26-0159522
Address: 13910 LYNMAR BLVD, TAMPA, FL, 33626, US
Mail Address: 13910 LYNMAR BLVD, TAMPA, FL, 33626, US
ZIP code: 33626
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366653545 2007-05-27 2022-08-24 13910 LYNMAR BLVD, TAMPA, FL, 336263123, US 13910 LYNMAR BLVD, TAMPA, FL, 33626, US

Contacts
Phone +1 866-834-7473
Fax 8774909111
Phone +1 813-792-3560

Authorized person
Name DANIEL J ROBICHAUD
Role CEO
Phone 8668347473

Taxonomy
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number 1313496
State FL
Is Primary Yes
Taxonomy Code 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME)
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 032072200
State FL
Issuer NCPDP PROVIDER IDENTIFICATION NUMBER
Number 5703548

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ONE SOURCE MEDICAL GROUP, LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 260159522 2024-10-14 ONE SOURCE MEDICAL GROUP, LLC 53
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2019-01-15
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BOULEVARD, TAMPA, FL, 33626

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing EDDIE SANCHEZ
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP, LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 260159522 2023-10-09 ONE SOURCE MEDICAL GROUP, LLC 54
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2019-01-15
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BOULEVARD, TAMPA, FL, 33626

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing EDDIE SANCHEZ
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP, LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 260159522 2022-07-26 ONE SOURCE MEDICAL GROUP, LLC 45
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2019-01-15
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BOULEVARD, TAMPA, FL, 33626

Signature of
Role Plan administrator
Date 2022-07-26
Name of individual signing EDDIE SANCHEZ
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP LLC 401K PROFIT SHARING PLAN & TRUST 2019 260159522 2021-11-18 ONE SOURCE MEDICAL GROUP LLC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BLVD, TAMPA, FL, 336263123

Signature of
Role Plan administrator
Date 2021-11-18
Name of individual signing EDDIE SANCHEZ
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP LLC 401K PROFIT SHARING PLAN & TRUST 2018 260159522 2019-06-03 ONE SOURCE MEDICAL GROUP LLC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BLVD, TAMPA, FL, 33626

Signature of
Role Plan administrator
Date 2019-06-03
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP LLC 401K PROFIT SHARING PLAN & TRUST 2017 260159522 2018-07-06 ONE SOURCE MEDICAL GROUP LLC 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13910 LYNMAR BLVD, TAMPA, FL, 33626

Signature of
Role Plan administrator
Date 2018-07-06
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP RETIREMENT PLAN 2016 260159522 2017-07-24 ONE SOURCE MEDICAL GROUP 29
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13505 ICOT BOULEVARD, SUITE 209, CLEARWATER, FL, 33760

Signature of
Role Plan administrator
Date 2017-07-24
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-24
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP RETIREMENT PLAN 2016 260159522 2017-11-14 ONE SOURCE MEDICAL GROUP 29
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13505 ICOT BOULEVARD, SUITE 209, CLEARWATER, FL, 33760

Signature of
Role Plan administrator
Date 2017-11-14
Name of individual signing ROBERT MUELLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-11-14
Name of individual signing ROBERT MUELLER
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP LLC 401K PROFIT SHARING PLAN & TRUST 2016 260159522 2017-05-16 ONE SOURCE MEDICAL GROUP LLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13505 ICOT BLVD STE 209, CLEARWATER, FL, 33760

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature
ONE SOURCE MEDICAL GROUP LLC 401K PROFIT SHARING PLAN & TRUST 2015 260159522 2016-05-24 ONE SOURCE MEDICAL GROUP LLC 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621112
Sponsor’s telephone number 8668347473
Plan sponsor’s address 13505 ICOT BLVD STE 209, CLEARWATER, FL, 33760

Signature of
Role Plan administrator
Date 2016-05-24
Name of individual signing DAVID LITTLER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
FRESH LEGAL PERSPECTIVE, PL Agent

Vice President

Name Role Address
Mueller Robert Vice President 13910 Lynmar Blvd, Tampa, FL, 33626

Chief Operating Officer

Name Role Address
Sternberg Eric Chief Operating Officer 13910 Lynmar Blvd, Tampa, FL, 33626

President

Name Role Address
Robichaud Jon President 13910 Lynmar Blvd, Tampa, FL, 33626

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-05-15 13910 LYNMAR BLVD, TAMPA, FL 33626 No data
CHANGE OF MAILING ADDRESS 2018-05-15 13910 LYNMAR BLVD, TAMPA, FL 33626 No data
LC STMNT OF RA/RO CHG 2017-06-05 No data No data
REGISTERED AGENT ADDRESS CHANGED 2017-06-05 6930 W LINEBAUGH AVE, TAMPA, FL 33625 No data
LC AMENDMENT 2015-11-02 No data No data
REGISTERED AGENT NAME CHANGED 2015-11-02 FRESH LEGAL PERSPECTIVE, PL No data

Documents

Name Date
ANNUAL REPORT 2024-03-15
AMENDED ANNUAL REPORT 2023-10-16
ANNUAL REPORT 2023-03-27
ANNUAL REPORT 2022-03-30
ANNUAL REPORT 2021-04-07
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-04-23
CORLCRACHG 2017-06-05
AMENDED ANNUAL REPORT 2017-03-18

Related by officers

Mueller Robert

REDDRESS USA, INC. GEMINI MEDICAL TECHNOLOGIES LLC EAST COAST SPORT & MARINE, LLC SURFSIDE TWELVE CONDOMINIUM ASSOCIATION, INC. THE UNITED CATHOLIC CHURCH, INC.

Sternberg Eric

EAST COAST SPORT & MARINE, LLC

Related by address

13910 LYNMAR BLVD, TAMPA, FL, 33626, US

LUXMANN LLC ARCHITECTURAL AMENITIES, LLC

13910 LYNMAR BLVD, TAMPA, FL, 33626, US

LUXMANN LLC ARCHITECTURAL AMENITIES, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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