| Entity Name: | HEART DOCTORS OF OCALA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Dec 2008 (16 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L08000118017 |
| FEI/EIN Number | 800327634 |
| Address: | 9401 SW HWY 200, BLDG. 6000, STE. 6003, OCALA, FL, 34481 |
| Mail Address: | P.O. BOX 1180, OCALA, FL, 34478 |
| ZIP code: | 34481 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275856064 | 2010-03-08 | 2011-12-16 | 2930 SE 31ST ST, OCALA, FL, 344716287, US | 10435 SE 170TH PL, SUMMERFIELD, FL, 344918998, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-624-7384 |
| Fax | 3526241924 |
| Phone | +1 352-347-8063 |
| Fax | 3523476187 |
Authorized person
| Name | MRS. SONYA NASSER |
| Role | ADMINISTRATOR |
| Phone | 3526247384 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME85309 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
| License Number | ME83972 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 000X4 |
| State | FL |
| Issuer | MEDICAID |
| Number | 262215700 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEART DOCTORS OF OCALA 401K PLAN | 2013 | 800327634 | 2014-07-29 | HEART DOCTORS OF OCALA | 18 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-07-29 |
| Name of individual signing | DR. JUSTIN FERNS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3526248779 |
| Plan sponsor’s address | 2930 SE 31ST STREET, OCALA, FL, 34471 |
Signature of
| Role | Plan administrator |
| Date | 2013-10-15 |
| Name of individual signing | JUSTIN FERNS, MD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3526248779 |
| Plan sponsor’s address | 2930 SE 31ST STREET, OCALA, FL, 34471 |
Plan administrator’s name and address
| Administrator’s EIN | 800327634 |
| Plan administrator’s name | HEART DOCTORS OF OCALA |
| Plan administrator’s address | 2930 SE 31ST STREET, OCALA, FL, 34471 |
| Administrator’s telephone number | 3526248779 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-15 |
| Name of individual signing | JUSTIN FERNS, MD |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| POPE TODD E | Agent | 13710 N US HIGHWAY 441, SUITE 100, THE VILLAGES, FL, 34491 |
| Name | Role | Address |
|---|---|---|
| NASSER ALI M | Manager | 9401 SW HWY 200 BLDG 6000 SUITE 6003, OCALA, FL, 34481 |
| FERNS JUSTIN M | Manager | 10435 SE 170TH PLACE, SUMMERFIELD, FL, 34491 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-08 | 9401 SW HWY 200, BLDG. 6000, STE. 6003, OCALA, FL 34481 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-08 | POPE, TODD ESQUIRE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-08 | 13710 N US HIGHWAY 441, SUITE 100, THE VILLAGES, FL 34491 | No data |
| LC AMENDMENT | 2010-01-22 | No data | No data |
| LC AMENDMENT | 2009-01-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-08 |
| ANNUAL REPORT | 2011-04-19 |
| LC Amendment | 2010-01-22 |
| ANNUAL REPORT | 2010-01-20 |
| ANNUAL REPORT | 2009-04-07 |
| LC Amendment | 2009-01-23 |
| Florida Limited Liability | 2008-12-30 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
