| Entity Name: | DOCTOR BOU PEDIATRICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Aug 2002 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 18 Nov 2011 (13 years ago) |
| Document Number: | P02000091358 |
| FEI/EIN Number | 522372743 |
| Address: | 1507 W. Reynolds St., Plant City, FL, 33563, US |
| Mail Address: | 20713 Center Oak Drive, Tampa, FL, 33647, US |
| ZIP code: | 33563 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316116536 | 2008-02-21 | 2018-04-09 | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 335634702, US | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 335634702, US | |||||||||||||||||||
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| Phone | +1 813-719-3716 |
Authorized person
| Name | SALVADOR ANGEL BOU-GAUTHIER |
| Role | CEO / PHYSICIAN |
| Phone | 8137193716 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 374065000 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DOCTOR BOU PEDIATRICS INC 401K PLAN | 2018 | 522372743 | 2019-06-12 | DOCTOR BOU PEDIATRICS INC | 6 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2019-06-12 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-06-12 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137193716 |
| Plan sponsor’s address | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 33563 |
Signature of
| Role | Plan administrator |
| Date | 2018-06-11 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137193716 |
| Plan sponsor’s address | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 33563 |
Signature of
| Role | Plan administrator |
| Date | 2017-07-10 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137193716 |
| Plan sponsor’s address | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 33563 |
Signature of
| Role | Plan administrator |
| Date | 2016-07-25 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2014-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137193716 |
| Plan sponsor’s address | 1507 W REYNOLDS ST STE A, PLANT CITY, FL, 33563 |
Signature of
| Role | Plan administrator |
| Date | 2015-09-09 |
| Name of individual signing | SALVADOR BOU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BOU-GAUTHIER SALVADOR | Agent | 20713 Center Oak Drive, Tampa, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| BOU-GAUTHIER SALVADOR | President | 1507 W REYNOLDS ST SUITE A, PLANT CITY, FL, 33563 |
| Name | Role | Address |
|---|---|---|
| Bou Salvador H | Chief Operating Officer | 20713 Center Oak Drive, Tampa, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2019-02-18 | 1507 W. Reynolds St., Suite A, Plant City, FL 33563 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-18 | 20713 Center Oak Drive, Tampa, FL 33647 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-12 | 1507 W. Reynolds St., Suite A, Plant City, FL 33563 | No data |
| REINSTATEMENT | 2011-11-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| AMENDED ANNUAL REPORT | 2023-05-03 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-03-24 |
| ANNUAL REPORT | 2021-04-01 |
| ANNUAL REPORT | 2020-04-22 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
