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  5. AMIR FAHMY MD.PA

AMIR FAHMY MD.PA

Company Details

Entity Name: AMIR FAHMY MD.PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 26 Feb 2002 (23 years ago)
Last Event: AMENDMENT
Event Date Filed: 19 Dec 2011 (13 years ago)
Document Number: P02000021494
FEI/EIN Number 450467216
Address: 3345 Burns Road, Palm Beach Gardens, FL, 33410, US
Mail Address: 3345 Burns Road, Palm Beach Gardens, FL, 33410, US
ZIP code: 33410
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083882328 2008-02-20 2012-11-06 3345 BURNS RD, STE#204, PALM BEACH GARDENS, FL, 334104324, US 3345 BURNS RD, STE#204, PALM BEACH GARDENS, FL, 334104324, US

Contacts
Phone +1 561-622-7604
Fax 5616227542

Authorized person
Name AMIR FAHMY
Role PHYSICIAN
Phone 5616227604

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME0076114
State FL
Is Primary Yes

Other Provider Identifiers
Issuer INDIVIDUAL NPI
Number 1912998436
State FL
Issuer MEDICAID
Number 265237400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AMIR FAHMY, MD, PA PSP 2015 450467216 2016-04-07 AMIR FAHMY, MD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410
AMIR FAHMY, MD, PA PSP 2015 450467216 2016-11-04 AMIR FAHMY, MD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410
AMIR FAHMY, MD, PA PSP 2014 450467216 2015-08-24 AMIR FAHMY, MD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2015-08-24
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
AMIR FAHMY, MD, PA PSP 2013 450467216 2014-10-08 AMIR FAHMY, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
AMIR FAHMY, MD, PA PSP 2012 450467216 2013-10-01 AMIR FAHMY, MD, PA 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2013-10-01
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
AMIR FAHMY, MD, PA PSP 2011 450467216 2012-10-08 AMIR FAHMY, MD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 450467216
Plan administrator’s name AMIR FAHMY, MD, PA
Plan administrator’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5614938288

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-08
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
AMIR FAHMY, MD, PA PSP 2010 450467216 2011-06-23 AMIR FAHMY, MD, PA 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614938288
Plan sponsor’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410

Plan administrator’s name and address
Administrator’s EIN 450467216
Plan administrator’s name AMIR FAHMY, MD, PA
Plan administrator’s address 3400 BURNS ROAD, SUITE 101, PALM BEACH GARDENS, FL, 33410
Administrator’s telephone number 5614938288

Signature of
Role Plan administrator
Date 2011-06-23
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-23
Name of individual signing FAY FAHMY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Miller John P Agent 2499 Glades Road, Boca Raton, FL, 33431

President

Name Role Address
Fahmy Amir President 3345 Burns Road, Palm Beach Gardnes, FL, 33410

Director

Name Role Address
Fahmy Amir Director 3345 Burns Road, Palm Beach Gardnes, FL, 33410
Salib Shady S Director 3345 Burns Road, Palm Beach Gardens, FL, 33410

Vice President

Name Role Address
Salib Shady S Vice President 3345 Burns Road, Palm Beach Gardens, FL, 33410

Secretary

Name Role Address
Fahmy Faten Secretary 3345 Burns Road, Boca Raton, FL, 33410

Treasurer

Name Role Address
Fahmy Faten Treasurer 3345 Burns Road, Boca Raton, FL, 33410

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000017208 FAMILY MEDICAL CENTER ACTIVE 2022-02-10 2027-12-31 No data 3345 BURNS ROAD, STE 204, PALM BEACH GARDENS, FL, 33410
G15000066254 FAMILY MEDICAL CENTER EXPIRED 2015-06-25 2020-12-31 No data 3345 BURNS ROAD, STE 204, PALM BEACH GARDENS, FL, 33410

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2020-07-09 3345 Burns Road, Suite 204, Palm Beach Gardens, FL 33410 No data
CHANGE OF MAILING ADDRESS 2020-07-09 3345 Burns Road, Suite 204, Palm Beach Gardens, FL 33410 No data
REGISTERED AGENT NAME CHANGED 2020-07-09 Miller, John P No data
REGISTERED AGENT ADDRESS CHANGED 2020-07-09 2499 Glades Road, Suite 304, Boca Raton, FL 33431 No data
AMENDMENT 2011-12-19 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-28
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-03-26
AMENDED ANNUAL REPORT 2020-07-09
ANNUAL REPORT 2020-03-23
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-04-27
ANNUAL REPORT 2017-04-19
AMENDED ANNUAL REPORT 2016-12-16

Related by officers

Miller John P

HK-LK INVESTMENTS, LLC OSPREY POINTE AT PELICAN MARSH CONDOMINIUM ASSOCIATION, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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