| Entity Name: | DR. B MEDICAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Apr 2020 (5 years ago) |
| Document Number: | L20000099078 |
| FEI/EIN Number | 85-0697927 |
| Address: | 1905 Clint Moore Rd., BOCA RATON, FL, 33496, US |
| Mail Address: | 1905 Clint Moore Rd., BOCA RATON, FL, 33496, US |
| ZIP code: | 33496 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881217081 | 2020-05-21 | 2021-12-08 | 1905 CLINT MOORE RD STE 202, BOCA RATON, FL, 334962660, US | 1905 CLINT MOORE RD STE 202, BOCA RATON, FL, 334962660, US | |||||||||||||||
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| Phone | +1 561-757-5530 |
| Fax | 5614303590 |
Authorized person
| Name | ALLYSON CHRISTINA BAGENHOLM |
| Role | OWNER |
| Phone | 5617575530 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR. B MEDICAL, PLLC 401(K) PLAN | 2023 | 850697927 | 2024-05-22 | DR. B MEDICAL, PLLC | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-05-23 |
| Name of individual signing | ALLYSON BAGENHOLM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5616852604 |
| Plan sponsor’s address | 1905 CLINT MOORE ROAD, SUITE 202, BOCA RATON, FL, 33496 |
Signature of
| Role | Plan administrator |
| Date | 2023-03-01 |
| Name of individual signing | ALLYSON BAGENHOLM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5616852604 |
| Plan sponsor’s address | 1905 CLINT MOORE ROAD, SUITE 202, BOCA RATON, FL, 33496 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-14 |
| Name of individual signing | ALLYSON BAGENHOLM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BAGENHOLM ALLYSON | Agent | 770 NE MARINE DRIVE, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| BAGENHOLM ALLYSON | Manager | 770 NE MARINE DRIVE, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-04-27 | 1905 Clint Moore Rd., Suite 202, BOCA RATON, FL 33496 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-11-23 | 1905 Clint Moore Rd., Suite 202, BOCA RATON, FL 33496 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-13 |
| ANNUAL REPORT | 2021-04-27 |
| Florida Limited Liability | 2020-04-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
