Home Page
Counties
Duval
Jacksonville
SAMUEL WALTERS, D.O., P.A.

SAMUEL WALTERS, D.O., P.A. - Florida Company Profile

Is this your business?

Get access!

Company Details

Entity Name:	SAMUEL WALTERS, D.O., P.A.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Inactive
Date Filed:	26 Dec 2001 (24 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
Address:	6531 103RD ST., JACKSONVILLE, FL, 32210
Mail Address:	6531 103RD ST., JACKSONVILLE, FL, 32210
ZIP code:	32210
City:	Jacksonville
County:	Duval
Place of Formation:	FLORIDA

Key Officers & Management

Name	Role	Address
WALTERS SAMUEL	Director	6531 103RD ST., JACKSONVILLE, FL, 32210
WALTERS SAMUEL	Agent	6531 103RD ST., JACKSONVILLE, FL, 32210

National Provider Identifier

NPI Number:

1285966499

Link:

View on NPI website

Authorized Person:

Name:

SAMUEL WALTERS

Role:

CEO/PHYSICIAN

Phone:

9047722727

Taxonomy:

Selected Taxonomy:

261QP2300X - Primary Care Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 904-772-2727

Fax:

9047721693

Form 5500 Series

Employer Identification Number (EIN):

010563833

Plan Year:

2021

Number Of Participants:

4

Sponsors Telephone Number:

9048030022

File:

Plan Year:

2021

Number Of Participants:

4

Sponsors Telephone Number:

9047722727

File:

Plan Year:

2020

Number Of Participants:

4

Sponsors Telephone Number:

9047722727

File:

Plan Year:

2019

Number Of Participants:

4

Sponsors Telephone Number:

9047722727

File:

Plan Year:

2017

Number Of Participants:

2

Sponsors Telephone Number:

9047722727

File:

Events

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	-

Documents

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

Paycheck Protection Program

Jobs Reported:

5

Initial Approval Amount:

$61,604

Date Approved:

2020-08-06

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$61,604

Race:

Black or African American

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$62,024.26

Servicing Lender:

Cross River Bank

Use of Proceeds:

Payroll: $61,604

Jobs Reported:

6

Initial Approval Amount:

$57,394

Date Approved:

2021-03-23

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$57,394

Race:

Black or African American

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$57,719.49

Servicing Lender:

Ameris Bank

Use of Proceeds:

Payroll: $57,394

Reviews Leave a review

This company hasn't received any reviews.

Date of last update: 02 Aug 2025

Sources: Florida Department of State