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  5. ALLIANCE MEDICAL ASSOCIATES, INC.

ALLIANCE MEDICAL ASSOCIATES, INC.

Company Details

Entity Name: ALLIANCE MEDICAL ASSOCIATES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 06 Nov 2002 (22 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 24 Oct 2023 (a year ago)
Document Number: P02000119799
FEI/EIN Number 010752705
Address: 1800 SE 17TH STREET, BUILDING 800, OCALA, FL, 34471
Mail Address: 1800 SE 17TH STREET, BUILDING 800, OCALA, FL, 34471
ZIP code: 34471
County: Marion
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1174577175 2006-05-22 2013-03-08 1800 SE 17TH ST, BLDG 800, OCALA, FL, 344714191, US 1800 SE 17TH STREET, BLD 800, OCALA, FL, 34471, US

Contacts
Phone +1 352-622-7268
Fax 3526226045

Authorized person
Name MRS. TAMMY LYNN BOSSIO
Role BILLING COORDINATOR
Phone 3526227268

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 270788800
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ALLIANCE MEDICAL ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2023 010752705 2024-09-10 ALLIANCE MEDICAL ASSOCIATES, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2024-09-10
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-10
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2022 010752705 2023-10-09 ALLIANCE MEDICAL ASSOCIATES, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-09
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2021 010752705 2022-06-27 ALLIANCE MEDICAL ASSOCIATES, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2022-06-27
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-27
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2020 010752705 2021-04-23 ALLIANCE MEDICAL ASSOCIATES, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2021-04-23
Name of individual signing JO ANN IRWIN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2019 010752705 2020-05-04 ALLIANCE MEDICAL ASSOCIATES, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2020-05-04
Name of individual signing JO ANN IRWIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-04
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2018 010752705 2019-06-19 ALLIANCE MEDICAL ASSOCIATES, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2019-06-17
Name of individual signing JOANN IRWIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-19
Name of individual signing ANWAR KHAN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2017 010752705 2018-06-01 ALLIANCE MEDICAL ASSOCIATES, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2018-06-01
Name of individual signing JOANN IRWIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-01
Name of individual signing JOANN IRWIN
Valid signature Filed with incorrect/unrecognized electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2016 010752705 2017-07-14 ALLIANCE MEDICAL ASSOCIATES, INC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2017-07-13
Name of individual signing JOANN IRWIN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2015 010752705 2016-07-06 ALLIANCE MEDICAL ASSOCIATES, INC 15
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2016-07-06
Name of individual signing JOANN IRWIN
Valid signature Filed with authorized/valid electronic signature
ALLIANCE MEDICAL ASSOCIATES, INC 401(K) PROFIT SHARING PLAN 2015 010752705 2017-07-14 ALLIANCE MEDICAL ASSOCIATES, INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3526227268
Plan sponsor’s address 1800 SE 17TH STREET BLD 800, OCALA, FL, 34471

Signature of
Role Plan administrator
Date 2017-07-14
Name of individual signing JOANN IRWIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KHAN ANWAR A Agent 1800 SE 17TH STREET, OCALA, FL, 34471

Director

Name Role Address
KHAN ANWAR A Director 3310 SW 58TH STREET, OCALA, FL, 34471
KANG MYEONG W Director 7254 SE 12TH CIRCLE, OCALA, FL, 34480
TE JESSIE D Director 684 SE 47TH LOOP, OCALA, FL, 34480

Events

Event Type Filed Date Value Description
REINSTATEMENT 2023-10-24 No data No data
REGISTERED AGENT NAME CHANGED 2023-10-24 KHAN, ANWAR AM.D. No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 No data No data
CANCEL ADM DISS/REV 2003-10-16 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2003-09-19 No data No data

Documents

Name Date
ANNUAL REPORT 2024-07-12
REINSTATEMENT 2023-10-24
ANNUAL REPORT 2022-02-10
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-18
ANNUAL REPORT 2018-01-08
ANNUAL REPORT 2017-01-25
ANNUAL REPORT 2016-02-29
ANNUAL REPORT 2015-01-13

Related by officers

KHAN ANWAR A

ISLAMIC RELIEF USA CORP. BLUEWATER LEGACY FOUNDATION,INC LEAD LOGISTICS SERVICES LLC 17TH STREET ALLIANCE MANAGEMENT CORPORATION

KANG MYEONG W

MS2B, LLC SORAMIRAE, LLC 17TH STREET ALLIANCE MANAGEMENT CORPORATION

TE JESSIE D

17TH STREET ALLIANCE MANAGEMENT CORPORATION

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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