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  5. FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC.

FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. - Florida Company Profile

Company Details

Entity Name: FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, 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: 25 Oct 2000 (24 years ago)
Document Number: P00000100272
FEI/EIN Number 651051563

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
Mail Address: 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
ZIP code: 33908
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255520714 2007-10-22 2009-09-23 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084176, US 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084176, US

Contacts
Phone +1 239-481-4911
Fax 2394816360

Authorized person
Name DR. DOUGLAS M STEVENS
Role DOCTOR
Phone 2394814911

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME0068103
State FL
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MEDICARE
Number 040012514
State FL
Issuer BCBS
Number 32891
State FL
Issuer AETNA
Number 5091536
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORT MYERS CENTRE FOR FACIAL PLASTIC LASER SURGERY, INC. CASH BALANCE PLAN 2019 651051563 2020-10-15 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2019 651051563 2020-10-14 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing TERESA STEVENS
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC LASER SURGERY, INC. CASH BALANCE PLAN 2016 651051563 2017-07-24 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2016 651051563 2017-09-05 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2017-09-05
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2015 651051563 2016-07-25 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2016-07-25
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2014 651051563 2015-07-06 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2013 651051563 2014-08-26 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2014-08-26
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-26
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2012 651051563 2013-09-11 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Signature of
Role Plan administrator
Date 2013-09-11
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-11
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2011 651051563 2012-05-23 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Plan administrator’s name and address
Administrator’s EIN 651051563
Plan administrator’s name FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC.
Plan administrator’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
Administrator’s telephone number 2394819292

Signature of
Role Plan administrator
Date 2012-05-23
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-23
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 401(K) PLAN 2010 651051563 2011-07-28 FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394819292
Plan sponsor’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Plan administrator’s name and address
Administrator’s EIN 651051563
Plan administrator’s name FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC.
Plan administrator’s address 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908
Administrator’s telephone number 2394819292

Signature of
Role Plan administrator
Date 2011-07-28
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-28
Name of individual signing DOUGLAS M. STEVENS, M.D.
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
STEVENS DOUGLAS M President 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 33908
STEVENS DOUGLAS M Vice President 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 33908
STEVENS DOUGLAS M Secretary 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 33908
STEVENS DOUGLAS M Treasurer 15721 NEW HAMPSHIRE CT, FORT MYERS, FL, 33908
STEVENS DOUGLAS M Agent 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2004-04-26 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL 33908 -
CHANGE OF MAILING ADDRESS 2004-04-26 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL 33908 -
REGISTERED AGENT ADDRESS CHANGED 2004-04-26 15721 NEW HAMPSHIRE COURT, FORT MYERS, FL 33908 -

Documents

Name Date
ANNUAL REPORT 2024-03-21
ANNUAL REPORT 2023-03-22
ANNUAL REPORT 2022-01-28
ANNUAL REPORT 2021-03-18
ANNUAL REPORT 2020-03-20
ANNUAL REPORT 2019-04-08
ANNUAL REPORT 2018-02-01
ANNUAL REPORT 2017-03-22
ANNUAL REPORT 2016-03-17
ANNUAL REPORT 2015-01-20

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DT STEVENS FAMILY, LLC - Inactive
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DT STEVENS FAMILY, LLC - Inactive
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Companies related by address

15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

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15721 NEW HAMPSHIRE COURT, FORT MYERS, FL, 33908

AUDIOLOGY CONSULTANTS OF SOUTHWEST FLORIDA, PL

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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