| Entity Name: | ORLANDO DERMATOLOGY CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Dec 2018 (6 years ago) |
| Document Number: | L18000292384 |
| FEI/EIN Number | 83-2905038 |
| Address: | 1040 Lake Sumter Landing, The Villages, FL, 32162, US |
| Mail Address: | 1040 Lake Sumter Landing, The Villages, FL, 32162, US |
| ZIP code: | 32162 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669251112 | 2023-09-25 | 2024-02-01 | 1040 LAKE SUMTER LNDG, THE VILLAGES, FL, 321622697, US | 118 W ORANGE ST, ALTAMONTE SPRINGS, FL, 327142537, US | |||||||||||||
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| Phone | +1 352-218-3211 |
Authorized person
| Name | TAREK S SHAATH |
| Role | MD |
| Phone | 3522183211 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARE DERMATOLOGY AND SKIN CANCER CENTERS 401(K) PLAN | 2023 | 832905038 | 2024-05-22 | ORLANDO DERMATOLOGY CLINIC LLC | 0 | |||||||||||||||||||||||||||||||
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| 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 | 2024-05-22 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SHAATH TAREK S | Agent | 1040 Lake Sumter Landing, The Villages, FL, 32162 |
| Name | Role | Address |
|---|---|---|
| SHAATH TAREK S | President | 1040 Lake Sumter Landing, The Villages, FL, 32162 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000044672 | CARE DERMATOLOGY AND SKIN CANCER CENTERS | ACTIVE | 2020-04-23 | 2025-12-31 | No data | 1040 LAKE SUMTER LANDING, THE VILLAGES, FL, 32162 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-03-15 | SHAATH, TAREK S | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-23 | 1040 Lake Sumter Landing, The Villages, FL 32162 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-23 | 1040 Lake Sumter Landing, The Villages, FL 32162 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-23 | 1040 Lake Sumter Landing, The Villages, FL 32162 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-04-23 |
| Florida Limited Liability | 2018-12-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
