| Entity Name: | THE CLINIC OF PLANT CITY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Sep 2014 (10 years ago) |
| Document Number: | L14000152075 |
| FEI/EIN Number | 47-1960767 |
| Address: | 802 WEST DR MARTIN LUTHER KING JR. BLVD, SUITE A, PLANT CITY, FL, 33563, US |
| Mail Address: | 802 WEST DR MARTIN LUTHER KING JR. BLVD, SUITE A, PLANT CITY, FL, 33563, US |
| ZIP code: | 33563 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417336413 | 2015-05-22 | 2016-06-29 | 802 W MARTIN LUTHER KING BLVD, SUITE A, PLANT CITY, FL, 335635105, US | 802 W MARTIN LUTHER KING BLVD, SUITE A, PLANT CITY, FL, 335635105, US | |||||||||||||||||||||||||
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| Phone | +1 813-754-7999 |
| Fax | 8137547111 |
Authorized person
| Name | GINGER SINGLETARY |
| Role | OWNER |
| Phone | 8137547999 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | 9280973 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015015800 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 2018 | 471960767 | 2019-07-30 | THE CLINIC OF PLANT CITY, LLC | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 570144607 |
| Plan administrator’s name | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY |
| Plan administrator’s address | PO BOX 1365, COLUMBIA, SC, 292021365 |
| Administrator’s telephone number | 8002567004 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-30 |
| Name of individual signing | GINGER SINGLETARY |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2018-06-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137547999 |
| Plan sponsor’s address | 802 W M L KING BLVD STE A, PLANT CITY, FL, 335635105 |
Plan administrator’s name and address
| Administrator’s EIN | 570144607 |
| Plan administrator’s name | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY |
| Plan administrator’s address | PO BOX 1365, COLUMBIA, SC, 292021365 |
| Administrator’s telephone number | 8002567004 |
Signature of
| Role | Employer/plan sponsor |
| Date | 2019-07-30 |
| Name of individual signing | GINGER SINGLETARY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| VCORP AGENT SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| SINGLETARY GINGER | President | 802 WEST MARTIN LUTHER KING JR. BLVD, PLANT CITY, FL, 33563 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-25 | VCORP AGENT SERVICES, INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-20 | 1200 S PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-23 | 802 WEST DR MARTIN LUTHER KING JR. BLVD, SUITE A, PLANT CITY, FL 33563 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-23 | 802 WEST DR MARTIN LUTHER KING JR. BLVD, SUITE A, PLANT CITY, FL 33563 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-03-13 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
