| Entity Name: | FAMILY PRACTICE-ST. CLOUD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
FAMILY PRACTICE-ST. CLOUD, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 23 Oct 1989 (35 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 24 Nov 2021 (3 years ago) |
| Document Number: | L25100 |
| FEI/EIN Number |
592974863
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602, US |
| Mail Address: | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602, US |
| ZIP code: | 33602 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336189190 | 2006-06-08 | 2023-02-06 | 3100 17TH ST, SAINT CLOUD, FL, 347696021, US | 3100 17TH ST, SAINT CLOUD, FL, 347696021, US | |||||||||||||||||||||||||
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| Phone | +1 407-892-0009 |
| Fax | 4078923285 |
Authorized person
| Name | DR. JOHN FREDERICK WILKER |
| Role | PRESIDENT |
| Phone | 4078920009 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0036943 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHEILD |
| Number | 34984 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | - |
| Polen Michael | Chief Executive Officer | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602 |
| Kollefrath Daniel | President | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602 |
| Pagidipati Rudrama | Vice President | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602 |
| Haber Michael | Secretary | 601 S. HARBOUR ISLAND BLVD., TAMPA, FL, 33602 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000156649 | PROHEALTH FAMILY PHYSICIANS | ACTIVE | 2021-11-24 | 2026-12-31 | - | 601 S HARBOUR ISLAND BLVD, SUITE 213-A, TAMPA, FL, 33602 |
| G15000071073 | PROHEALTH KISSIMMEE | EXPIRED | 2015-07-08 | 2020-12-31 | - | 3100 17TH STREET, SAINT CLOUD, FL, 34769 |
| G13000020815 | PROHEALTH HARMONY | EXPIRED | 2013-02-28 | 2018-12-31 | - | 7264 HARMONY SQUARE DR. SOUTH, HARMONY, FL, 34773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-07-26 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | - |
| REGISTERED AGENT NAME CHANGED | 2023-07-26 | C T CORPORATION SYSTEM | - |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-25 | 601 S. HARBOUR ISLAND BLVD., SUITE 200, TAMPA, FL 33602 | - |
| CHANGE OF MAILING ADDRESS | 2023-04-25 | 601 S. HARBOUR ISLAND BLVD., SUITE 200, TAMPA, FL 33602 | - |
| AMENDMENT AND NAME CHANGE | 2021-11-24 | FAMILY PRACTICE-ST. CLOUD, INC. | - |
| AMENDMENT | 2016-11-14 | - | - |
| AMENDMENT | 2004-02-11 | - | - |
| REINSTATEMENT | 1998-04-09 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1997-09-26 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| Reg. Agent Change | 2023-07-26 |
| ANNUAL REPORT | 2023-04-25 |
| AMENDED ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2022-02-23 |
| Amendment and Name Change | 2021-11-24 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-03-29 |
| ANNUAL REPORT | 2018-02-02 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
