| Entity Name: | THE DERMATOLOGY INSTITUTE AND SKIN CANCER CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Apr 2020 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 06 Oct 2021 (3 years ago) |
| Document Number: | L20000107710 |
| FEI/EIN Number | 850782409 |
| Address: | 2783 Brownwood Boulevard, The Villages, FL, 32163, US |
| Mail Address: | 2783 Brownwood Boulevard, The Villages, FL, 32163, US |
| ZIP code: | 32163 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891319422 | 2020-05-29 | 2021-03-21 | 2783 BROWNWOOD BLVD, THE VILLAGES, FL, 321632005, US | 2783 BROWNWOOD BLVD, THE VILLAGES, FL, 32163, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 352-834-7546 |
Authorized person
| Name | CHARLES KNAPP |
| Role | CO-OWNER |
| Phone | 3528347546 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THE DERMATOLOGY INSTITUTE AND SKIN CANCER CENTER, LLC 401(K) PLAN | 2023 | 850782409 | 2024-05-31 | THE DERMATOLOGY INSTITUTE AND SKIN CANCER CENTER, LLC | 8 | |||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-31 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| 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 | 621399 |
| Sponsor’s telephone number | 7274528381 |
| Plan sponsor’s address | 2783 BROWNWOOD BLVD, THE VILLAGES, FL, 32163 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-06 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Knapp Charles MD | Agent | 2783 Brownwood Blvd, The Villages, FL, 32163 |
| Name | Role | Address |
|---|---|---|
| KNAPP CHARLES MD | Manager | 2783 BROWNWOOD BOULEVARD, THE VILLAGES, FL, 32163 |
| MARKUS BRANDON DO | Manager | 2783 BROWNWOOD BOULEVARD, THE VILLAGES, FL, 32163 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-25 | 2783 Brownwood Boulevard, The Villages, FL 32163 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-25 | 2783 Brownwood Boulevard, The Villages, FL 32163 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-25 | 2783 Brownwood Blvd, The Villages, FL 32163 | No data |
| REINSTATEMENT | 2021-10-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-10-06 | Knapp, Charles, MD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-26 |
| REINSTATEMENT | 2021-10-06 |
| Florida Limited Liability | 2020-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
