| Entity Name: | VIVIFY PLASTIC SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Feb 2018 (7 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 12 Mar 2024 (a year ago) |
| Document Number: | L18000049065 |
| FEI/EIN Number | 82-4627269 |
| Address: | 1000 W KENNEDY BLVD STE 202, TAMPA, FL 33606 |
| Mail Address: | 1000 W KENNEDY BLVD STE 202, TAMPA, FL 33606 |
| ZIP code: | 33606 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073093175 | 2018-08-17 | 2018-11-27 | 1000 W KENNEDY BLVD STE 202, TAMPA, FL, 336061940, US | 1000 W KENNEDY BLVD, SUITE 202, TAMPA, FL, 336062494, US | |||||||||||||||||||
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| Phone | +1 406-848-4391 |
| Fax | 5093231607 |
Authorized person
| Name | DR. DALLAS R. BUCHANAN |
| Role | OWNER/PROVIDER |
| Phone | 8332848439 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| License Number | ME134199 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VIVIFY PLASTIC SURGERY 401(K) PLAN | 2023 | 824627269 | 2024-07-11 | VIVIFY PLASTIC SURGERY, LLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-11 |
| Name of individual signing | DALLAS BUCHANAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8332848439 |
| Plan sponsor’s address | 1000 W. KENNEDY BLVD. SUITE 202, TAMPA, FL, 33606 |
Signature of
| Role | Plan administrator |
| Date | 2023-08-15 |
| Name of individual signing | DALLAS BUCHANAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| LEGALINC CORPORATE SERVICES INC. | Agent |
| Name | Role | Address |
|---|---|---|
| BUCHANAN, DALLAS | Authorized Member | 1000 W KENNEDY BLVD, 202 TAMPA, FL 33606 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-12 | 1000 W KENNEDY BLVD STE 202, TAMPA, FL 33606 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-03-12 | LEGALINC CORPORATE SERVICES INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-12 | 476 RIVERSIDE AVE, JACKSONVILLE, FL 32202 | No data |
| LC STMNT OF RA/RO CHG | 2024-03-12 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-12 | 1000 W KENNEDY BLVD STE 202, TAMPA, FL 33606 | No data |
| LC AMENDMENT | 2018-05-16 | No data | No data |
| LC AMENDMENT | 2018-04-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| CORLCRACHG | 2024-03-12 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-04-30 |
| LC Amendment | 2018-05-16 |
| LC Amendment | 2018-04-03 |
| Florida Limited Liability | 2018-02-23 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6437427209 | 2020-04-28 | 0455 | PPP | 1000 W KENNEDY BLVD Suite 202, TAMPA, FL, 33606-1940 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Feb 2025
Sources: Florida Department of State
