| Entity Name: | TAMPA BAY PULMONARY ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Dec 1989 (35 years ago) |
| Document Number: | L37379 |
| FEI/EIN Number | 650173173 |
| Address: | 2810 WEST WATERS AVENUE, TAMPA, FL, 33614 |
| Mail Address: | 2810 WEST WATERS AVENUE, TAMPA, FL, 33614 |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013947282 | 2006-07-04 | 2008-07-09 | 2810 W WATERS AVE, TAMPA, FL, 336141853, US | 2810 W WATERS AVE, TAMPA, FL, 336141853, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-935-5501 |
| Fax | 8139338784 |
Authorized person
| Name | DR. ASHOK K MODH |
| Role | PRESIDENT |
| Phone | 8139355501 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 053742000 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | C12157 |
| State | FL |
| Issuer | BCBS |
| Number | 72916 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAMPA BAY PULMONARY ASSOCIATES, P.A. DEFINED BENEFIT PENSION PLAN AND TRUST | 2010 | 651073173 | 2011-07-28 | TAMPA BAY PULMONARY ASSOCIATES, P.A | 8 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 651073173 |
| Plan administrator’s name | TAMPA BAY PULMONARY ASSOCIATES, P.A |
| Plan administrator’s address | 2810 W. WATERS AVENUE, TAMPA, FL, 34614 |
| Administrator’s telephone number | 8139355501 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-28 |
| Name of individual signing | MENDY MCKENDRY |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 005 |
| Effective date of plan | 2003-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8139355501 |
| Plan sponsor’s address | 2810 W. WATERS AVENUE, TAMPA, FL, 34614 |
Plan administrator’s name and address
| Administrator’s EIN | 651073173 |
| Plan administrator’s name | TAMPA BAY PULMONARY ASSOCIATES, P.A |
| Plan administrator’s address | 2810 W. WATERS AVENUE, TAMPA, FL, 34614 |
| Administrator’s telephone number | 8139355501 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-15 |
| Name of individual signing | MENDY MCKENDRY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MODH ASHOK | Agent | 2810 W WATERS AVENUE, TAMPA, FL, 33614 |
| Name | Role | Address |
|---|---|---|
| MODH ASHOK M | Director | 2810 W WATERS AVE, TAMPA, FL, 33614 |
| MANDALIYA NAISHADH M | Director | 2810 W. WATERS AVE., TAMPA, FL, 33618 |
| CARDONA JERGES J | Director | 2810 WEST WATERS AVENUE, TAMPA, FL, 33614 |
| PATEL NIRAV M | Director | 2810 W. WATERS AVE., TAMPA, FL, 33614 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000028207 | TAMPABAY SLEEP CENTER | ACTIVE | 2019-02-27 | 2029-12-31 | No data | 11329 CARROLLWOOD DRIVE, A, TAMPA, FL, 33618 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2007-06-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| CANCEL ADM DISS/REV | 2004-12-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| NAME CHANGE AMENDMENT | 2002-08-29 | TAMPA BAY PULMONARY ASSOCIATES, P.A. | No data |
| REINSTATEMENT | 1995-09-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
