| Entity Name: | SAMUEL WALTERS, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
SAMUEL WALTERS, D.O., P.A. 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: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 26 Dec 2001 (23 years ago) |
| Date of dissolution: | 23 Sep 2022 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (3 years ago) |
| Document Number: | P01000121193 |
| FEI/EIN Number |
010563833
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 6531 103RD ST., JACKSONVILLE, FL, 32210 |
| Mail Address: | 6531 103RD ST., JACKSONVILLE, FL, 32210 |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285966499 | 2010-02-12 | 2010-07-03 | 6531 103RD ST, JACKSONVILLE, FL, 322107131, US | 6531 103RD ST, JACKSONVILLE, FL, 322107131, US | |||||||||||||||||||||||||
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| Phone | +1 904-772-2727 |
| Fax | 9047721693 |
Authorized person
| Name | SAMUEL WALTERS |
| Role | CEO/PHYSICIAN |
| Phone | 9047722727 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | OS8337 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261008600 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMUEL WALTERS D O P A 401 K PROFIT SHARING PLAN TRUST | 2017 | 010563833 | 2018-07-31 | SAMUEL WALTERS D O P A | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2018-07-31 |
| Name of individual signing | SAMUEL WALTERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621510 |
| Sponsor’s telephone number | 9047722727 |
| Plan sponsor’s address | 6531 103RD ST, JACKSONVILLE, FL, 322107131 |
Signature of
| Role | Plan administrator |
| Date | 2018-07-31 |
| Name of individual signing | SAMUEL WALTERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621510 |
| Sponsor’s telephone number | 9047722727 |
| Plan sponsor’s address | 6531 103RD ST, JACKSONVILLE, FL, 322107131 |
Signature of
| Role | Plan administrator |
| Date | 2018-07-31 |
| Name of individual signing | SAMUEL WALTERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621510 |
| Sponsor’s telephone number | 9047722727 |
| Plan sponsor’s address | 6531 103RD ST, JACKSONVILLE, FL, 322107131 |
Signature of
| Role | Plan administrator |
| Date | 2018-07-31 |
| Name of individual signing | SAMUEL WALTERS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WALTERS SAMUEL | Director | 6531 103RD ST., JACKSONVILLE, FL, 32210 |
| WALTERS SAMUEL | Agent | 6531 103RD ST., JACKSONVILLE, FL, 32210 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | - | - |
| REINSTATEMENT | 2011-10-04 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2009-06-23 | 6531 103RD ST., JACKSONVILLE, FL 32210 | - |
| CHANGE OF MAILING ADDRESS | 2009-06-23 | 6531 103RD ST., JACKSONVILLE, FL 32210 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2009-06-23 | 6531 103RD ST., JACKSONVILLE, FL 32210 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-24 |
| ANNUAL REPORT | 2020-06-13 |
| ANNUAL REPORT | 2019-04-28 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-04-01 |
| ANNUAL REPORT | 2016-07-16 |
| ANNUAL REPORT | 2015-04-25 |
| ANNUAL REPORT | 2014-02-01 |
| ANNUAL REPORT | 2013-03-02 |
| ANNUAL REPORT | 2012-03-22 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
