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  5. MEDI CLINICS PRIMARY CARE LLC

MEDI CLINICS PRIMARY CARE LLC

Company Details

Entity Name: MEDI CLINICS PRIMARY CARE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 12 Oct 2012 (12 years ago)
Document Number: L12000130305
FEI/EIN Number 46-1178012
Mail Address: 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609, US
Address: 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609
ZIP code: 33609
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1609120534 2012-10-30 2024-01-19 502 S MACDILL AVE, TAMPA, FL, 336093039, US 502 S MACDILL AVE, TAMPA, FL, 336093039, US

Contacts
Phone +1 813-465-9999
Fax 8138771222
Fax 8138316292

Authorized person
Name DR. VENKATA JAYA PRATAP BIREDDY
Role OWNER/ADMINISTRATOR
Phone 8134659999

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary No
Taxonomy Code 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician
Is Primary No
Taxonomy Code 261QM1300X - Multi-Specialty Clinic/Center
Is Primary Yes
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDI CLINICS PRIMARY CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 461178012 2024-06-07 MEDI CLINICS PRIMARY CARE LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134659999
Plan sponsor’s address 5020 S MACDILL AVENUE, TAMPA, FL, 33609

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2024-06-07
Name of individual signing ERISA FIDUCIARY SERVICES, INC
Valid signature Filed with authorized/valid electronic signature
MEDI CLINICS PRIMARY CARE 401(K) PLAN 2022 461178012 2023-09-18 MEDI CLINICS PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134659999
Plan sponsor’s address 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2023-09-17
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-17
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature
MEDI CLINICS PRIMARY CARE 401(K) PLAN 2021 461178012 2022-09-30 MEDI CLINICS PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134659999
Plan sponsor’s address 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2022-09-30
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-09-30
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature
MEDI CLINICS PRIMARY CARE 401(K) PLAN 2020 461178012 2021-10-08 MEDI CLINICS PRIMARY CARE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 8134659999
Plan sponsor’s address 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Signature of
Role Plan administrator
Date 2021-10-08
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-08
Name of individual signing VENKATA BIREDDY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Bireddy Venkata J Agent 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Managing Member

Name Role Address
BIREDDY VENKATA Managing Member 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000100950 MEDI CLINICS EXPIRED 2012-10-16 2017-12-31 No data 502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2018-01-08 Bireddy, Venkata J No data
CHANGE OF MAILING ADDRESS 2014-03-11 502 SOUTH MACDILL AVENUE, TAMPA, FL 33609 No data
REGISTERED AGENT ADDRESS CHANGED 2014-03-11 502 SOUTH MACDILL AVENUE, TAMPA, FL 33609 No data

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-03-09
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-01-14
ANNUAL REPORT 2020-01-17
ANNUAL REPORT 2019-03-14
ANNUAL REPORT 2018-01-08
ANNUAL REPORT 2017-03-17
ANNUAL REPORT 2016-03-03
ANNUAL REPORT 2015-03-20

Related by officers

BIREDDY VENKATA

BIREDDY REAL ESTATE GROUP LLC MEDI-GREEN COMPASSIONATE CARE LLC ULTRA FAST URGENT CARE LIMITED LIABILITY COMPANY

Related by address

502 SOUTH MACDILL AVENUE, TAMPA, FL, 33609, US

SALON SALVATORE CHRISTIAN, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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