| Entity Name: | BLACKSHEEP MEDICAL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
BLACKSHEEP MEDICAL LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 15 Aug 2013 (12 years ago) |
| Document Number: | L13000115209 |
| FEI/EIN Number |
463419861
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174, US |
| Mail Address: | 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770913360 | 2013-11-18 | 2013-11-18 | 1425 HAND AVE, SUITE L, ORMOND BEACH, FL, 321741135, US | 1425 HAND AVE, SUITE L, ORMOND BEACH, FL, 321741135, US | |||||||||||||||
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| Phone | +1 386-256-3977 |
| Fax | 3868725004 |
Authorized person
| Name | DANIEL A SEEDOR |
| Role | MGMR |
| Phone | 3862563977 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLACKSHEEP MEDICAL LLC 401(K) PLAN | 2023 | 463419861 | 2024-07-29 | BLACKSHEEP MEDICAL, LLC | 15 | |||||||||||||||||||||||
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| BLACKSHEEP MEDICAL LLC 401(K) PLAN | 2022 | 463419861 | 2023-09-15 | BLACKSHEEP MEDICAL, LLC | 14 | |||||||||||||||||||||||
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| BLACKSHEEP MEDICAL LLC 401(K) PLAN | 2021 | 463419861 | 2022-08-05 | BLACKSHEEP MEDICAL, LLC | 12 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-08-05 |
| Name of individual signing | DANIEL SEEDOR |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3862563977 |
| Plan sponsor’s address | 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-23 |
| Name of individual signing | DANIEL SEEDOR |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3862563977 |
| Plan sponsor’s address | 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2020-09-28 |
| Name of individual signing | DANIEL SEEDOR |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| CHEWNING JOHN R | Managing Member | 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174 |
| SEEDOR DANIEL A | Managing Member | 1425 HAND AVENUE, ORMOND BEACH, FL, 32174 |
| JOHN R. CHEWNING, DO, PA | Agent | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000419150 | TERMINATED | 2018-30339-CICI | CIRCUIT COURT, VOLUSIA COUNTY | 2018-06-11 | 2023-06-22 | $15,942.88 | VANN DATA SERVICES, INC., 1801 DUNN AVENUE, DAYTONA BEACH FL 32114 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-05 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-02-21 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-27 |
| ANNUAL REPORT | 2016-01-15 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8409417709 | 2020-05-01 | 0491 | PPP | 1425 HAND AVE STE L, ORMOND BEACH, FL, 32174-1136 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
