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  5. MELVIN C. LU, M.D., L.L.C.

MELVIN C. LU, M.D., L.L.C.

Company Details

Entity Name: MELVIN C. LU, M.D., L.L.C.
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 07 Jan 2013 (12 years ago)
Last Event: CONVERSION
Event Date Filed: 07 Jan 2013 (12 years ago)
Document Number: L13000003678
FEI/EIN Number 59-3545113
Address: 5402 JOBETH DRIVE, NEW PORT RICHEY, FL, 34652, US
Mail Address: PO BOX 1496, NEW PORT RICHEY, FL, 34656-1496, US
ZIP code: 34652
County: Pasco
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1679761563 2007-10-05 2014-04-28 10133 CORTEZ BLVD., BROOKSVILLE, FL, 346136385, US 10133 CORTEZ BLVD., BROOKSVILLE, FL, 346136385, US

Contacts
Phone +1 352-596-4401
Fax 3525964431

Authorized person
Name MR. MELVIN C LU
Role OWNER/PRESIDENT
Phone 3525964401

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME70999
State FL
Is Primary Yes
Taxonomy Code 207ND0101X - MOHS-Micrographic Surgery Physician
License Number ME70999
State FL
Is Primary No
Taxonomy Code 207ND0900X - Dermatopathology Physician
License Number ME70999
State FL
Is Primary No
Taxonomy Code 207NS0135X - Procedural Dermatology Physician
License Number ME70999
State FL
Is Primary No
Taxonomy Code 363A00000X - Physician Assistant
License Number PA2766
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICARE RAILROAD
Number CI5866
Issuer BCBS GROUP NUMBER
Number 38300A
Issuer BCBS GROUP NUMBER
Number 38300

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2023 593545113 2024-06-04 MELVIN C. LU, M.D., L.L.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 1352596440
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2024-06-04
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-04
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2022 593545113 2023-04-20 MELVIN C. LU, M.D., L.L.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2023-04-20
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2022 593545113 2023-03-22 MELVIN C. LU, M.D., L.L.C. 14
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2023-03-22
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2021 593545113 2022-05-23 MELVIN C. LU, M.D., L.L.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2022-05-23
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2020 593545113 2021-04-14 MELVIN C. LU, M.D., L.L.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2021-04-14
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2019 593545113 2020-04-29 MELVIN C. LU, M.D., L.L.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2020-04-29
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2018 593545113 2019-05-28 MELVIN C. LU, M.D., L.L.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2019-05-28
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2017 593545113 2018-04-23 MELVIN C. LU, M.D., L.L.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2018-04-23
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2016 593545113 2017-04-06 MELVIN C. LU, M.D., L.L.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2017-04-06
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature
MELVIN C. LU, M.D., L.L.C. 401(K) P/S PLAN 2015 593545113 2016-05-16 MELVIN C. LU, M.D., L.L.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Plan sponsor’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Plan administrator’s name and address
Administrator’s EIN 593545113
Plan administrator’s name MELVIN C. LU, M.D., L.L.C.
Plan administrator’s address 10133 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Signature of
Role Plan administrator
Date 2016-05-16
Name of individual signing BRIANNE MILLER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GASSMAN ALAN S Agent 1245 COURT ST, CLEARWATER, FL, 33756

Manager

Name Role Address
LU MELVIN C Manager 5402 JOBETH DRIVE, NEW PORT RICHEY, FL, 34652

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2014-03-14 5402 JOBETH DRIVE, NEW PORT RICHEY, FL 34652 No data
CHANGE OF MAILING ADDRESS 2014-03-14 5402 JOBETH DRIVE, NEW PORT RICHEY, FL 34652 No data
CONVERSION 2013-01-07 No data CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P98000101297. CONVERSION NUMBER 900000128439

Documents

Name Date
ANNUAL REPORT 2024-02-09
ANNUAL REPORT 2023-01-11
ANNUAL REPORT 2022-01-24
ANNUAL REPORT 2021-01-12
ANNUAL REPORT 2020-02-05
ANNUAL REPORT 2019-01-10
ANNUAL REPORT 2018-02-06
ANNUAL REPORT 2017-02-03
ANNUAL REPORT 2016-02-09
ANNUAL REPORT 2015-01-19

Related by officers

LU MELVIN C

360 PHYSICIAN ALLIANCE, LLC M&M PROPERTIES OF HERNANDO, FL, L.L.C. LIEN & LU, M.D.'S, P.A.

GASSMAN ALAN S

ENCOMPASS MARKETING, LLC ASA EQUITY INVESTMENTS, L.L.C. LE CONDOMINIUM, L.L.C. SFJ HOLDINGS, L.L.C. WITTENSTEIN FAMILY HOLDINGS, L.L.C. MOBILE HIGHWAY PROPERTY HOLDINGS, L.L.C. LAKE KEOWEE, L.L.C. BEST AMERICAN MEDICAL CARE, L.L.C. PINELLAS COASTAL PROPERTY MANAGEMENT, L.L.C. SAFETY HARBOR PROPERTY HOLDINGS, L.L.C.

Related by address

5402 JOBETH DRIVE, NEW PORT RICHEY, FL, 34652, US

M&M REAL ESTATE HOLDINGS OF HERNANDO, FLORIDA, L.L.C. M&M PROPERTIES OF HERNANDO, FL, L.L.C.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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