| Entity Name: | SUPERIOR PODIATRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Jul 2018 (7 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 03 May 2019 (6 years ago) |
| Document Number: | L18000174391 |
| FEI/EIN Number | 83-1365464 |
| Address: | 1690 US Highway 1 South, ST. AUGUSTINE, FL, 32084, US |
| Mail Address: | 1690 US Highway 1 South, ST. AUGUSTINE, FL, 32084, US |
| ZIP code: | 32084 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457839839 | 2018-07-30 | 2020-11-05 | 1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL, 320846024, US | 1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL, 320846024, US | |||||||||||||||||||||||||
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| Phone | +1 904-436-8001 |
| Fax | 9043776776 |
Authorized person
| Name | DR. JOHN RANDALL NORTHRUP |
| Role | PRESIDENT/OWNER |
| Phone | 9044368001 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | No |
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101522100 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUPERIOR PODIATRY LLC 401K PLAN | 2023 | 831365464 | 2024-06-18 | SUPERIOR PODIATRY LLC | 9 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-18 |
| Name of individual signing | KEN MAZZIE |
| 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 | 9547561792 |
| Plan sponsor’s address | 1690 US HWY 1 SOUTH, ST. AUGUSTINE, FL, 32084 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-28 |
| Name of individual signing | KEN MAZZIE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| NORTHRUP JOHN | Agent | 1690 US Highway 1 South, ST. AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| NORTHRUP JOHN | Manager | 1690 US Highway 1 South, ST. AUGUSTINE, FL, 32084 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000110220 | SUPERIOR FOOT ANKLE & WOUND CARE | ACTIVE | 2023-09-08 | 2028-12-31 | No data | 1690 US HIGHWAY 1 SOUTH, STE C, ST AUGUSTINE, FL, 32084 |
| G23000055705 | SUPERIOR PODIATRY LLC | ACTIVE | 2023-05-02 | 2028-12-31 | No data | 1690 US HIGHWAY 1 SOUTH, STE C, ST AUGUSTINE, FL, 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-14 | NORTHRUP, JOHN | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-06 | 1690 US Highway 1 South, STE C, ST. AUGUSTINE, FL 32084 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-06 | 1690 US Highway 1 South, STE C, ST. AUGUSTINE, FL 32084 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-06 | 1690 US Highway 1 South, SUITE C, ST. AUGUSTINE, FL 32084 | No data |
| LC AMENDMENT AND NAME CHANGE | 2019-05-03 | SUPERIOR PODIATRY, LLC | No data |
| LC AMENDMENT AND NAME CHANGE | 2018-09-05 | ST. JOHNS FOOT AND ANKLE SPECIALISTS, LLC | No data |
| LC NAME CHANGE | 2018-07-30 | ST. JOHNS FOOT AND ANKLE SPECIALIST, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-01-06 |
| LC Amendment and Name Change | 2019-05-03 |
| ANNUAL REPORT | 2019-04-22 |
| LC Amendment and Name Change | 2018-09-05 |
| LC Name Change | 2018-07-30 |
| Florida Limited Liability | 2018-07-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
