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MB PRIMARY CARE LLC

Company Details

Entity Name: MB PRIMARY CARE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 30 May 2017 (8 years ago)
Document Number: L17000117877
FEI/EIN Number 82-1762585
Address: 2213 GLENMOOR RD S, CLEARWATER, FL, 33764
Mail Address: 2213 GLENMOOR RD S, CLEARWATER, FL, 33764
ZIP code: 33764
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003336181 2017-06-21 2017-06-21 2213 GLENMOOR RD S, CLEARWATER, FL, 337644922, US 9555 SEMINOLE BLVD STE 104, SEMINOLE, FL, 337722522, US

Contacts

Phone +1 816-258-0431
Fax 8666321343
Phone +1 727-394-1500

Authorized person

Name MELISSA MARIE BIBB
Role OWNER
Phone 8162580431

Taxonomy

Taxonomy Code 363L00000X - Nurse Practitioner
License Number ARNP9400491
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAL LICENSE
Number ARNP9400491
State FL
Issuer MEDICAID
Number 01857390
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MB PRIMARY CARE 401(K) PLAN 2023 821762585 2024-05-16 MB PRIMARY CARE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 7273941500
Plan sponsor’s address 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2024-05-16
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
MB PRIMARY CARE 401(K) PLAN 2022 821762585 2023-05-27 MB PRIMARY CARE LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 7273941500
Plan sponsor’s address 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
MB PRIMARY CARE 401(K) PLAN 2021 821762585 2022-06-02 MB PRIMARY CARE LLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-01-01
Business code 621111
Sponsor’s telephone number 7273941500
Plan sponsor’s address 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Plan administrator’s name and address

Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of

Role Plan administrator
Date 2022-06-02
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BIBB MELISSA M Agent 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Manager

Name Role Address
BIBB MELISSA M Manager 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Authorized Representative

Name Role Address
BIBB RONALD DIII Authorized Representative 2213 GLENMOOR RD S, CLEARWATER, FL, 33764

Documents

Name Date
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-03-21
ANNUAL REPORT 2022-04-11
ANNUAL REPORT 2021-04-02
ANNUAL REPORT 2020-06-26
ANNUAL REPORT 2019-05-02
ANNUAL REPORT 2018-03-05
Florida Limited Liability 2017-05-30

Date of last update: 02 Feb 2025

Sources: Florida Department of State