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  5. PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.

PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.

Company Details

Entity Name: PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 27 Dec 2002 (22 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 18 Feb 2019 (6 years ago)
Document Number: P03000005933
FEI/EIN Number 11-3672271
Address: 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458
Mail Address: 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458
ZIP code: 33458
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1578676870 2006-08-17 2023-05-25 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458, US 4601 MILITARY TRL, SUITE 208, JUPITER, FL, 334584834, US

Contacts
Phone +1 561-795-3787
Fax 5617980003

Authorized person
Name DR. HAROLD BAFITIS
Role MEDICAL DIRECTOR
Phone 5617953787

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number OS0005647
State FL
Is Primary Yes

Other Provider Identifiers
Issuer NEIGHBORHOOD HEALTH
Number 3435WELL
State FL
Issuer STAYWELL & WELLCARE
Number 06388
State FL
Issuer BLUE CROSS BLUE SHIELD
Number 80174
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2015 113672271 2016-01-15 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2015 113672271 2016-01-15 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 8
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2014 113672271 2015-10-01 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2013 113672271 2014-10-14 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2012 113672271 2013-09-27 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SIUTE 208, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing HAROLD BAFITIS, DO
Valid signature Filed with authorized/valid electronic signature
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2011 113672271 2012-10-05 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SIUTE 208, JUPITER, FL, 33458

Plan administrator’s name and address
Administrator’s EIN 113672271
Plan administrator’s name PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.
Plan administrator’s address 4601 MILITARY TRAIL, SIUTE 208, JUPITER, FL, 33458
Administrator’s telephone number 5617953787

Signature of
Role Plan administrator
Date 2012-10-05
Name of individual signing HAROLD BAFITIS, DO
Valid signature Filed with authorized/valid electronic signature
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2010 113672271 2011-07-27 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458

Plan administrator’s name and address
Administrator’s EIN 113672271
Plan administrator’s name PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.
Plan administrator’s address 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL, 33458
Administrator’s telephone number 5617953787

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing HAROLD BAFITIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-27
Name of individual signing HAROLD BAFITIS
Valid signature Filed with authorized/valid electronic signature
PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES 401(K) PLAN 2009 113672271 2010-09-30 PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 5617953787
Plan sponsor’s address 4601 MILITARY TRAIL, SIUTE 209, JUPITER, FL, 33458

Plan administrator’s name and address
Administrator’s EIN 113672271
Plan administrator’s name PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES, INC.
Plan administrator’s address 4601 MILITARY TRAIL, SIUTE 209, JUPITER, FL, 33458
Administrator’s telephone number 5617953787

Signature of
Role Plan administrator
Date 2010-09-28
Name of individual signing DR. HAROLD BAFITIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-28
Name of individual signing DR. HAROLD BAFITIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Ginori, Elizabeth Agent 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458

Director

Name Role Address
BAFITIS, HAROLD Director 4601 MILITARY TRAIL, SUITE 208 JUPITER, FL 33458

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2023-03-27 Ginori, Elizabeth No data
REGISTERED AGENT ADDRESS CHANGED 2023-03-27 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458 No data
REINSTATEMENT 2019-02-18 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-04-28 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458 No data
CHANGE OF MAILING ADDRESS 2009-04-28 4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458 No data

Documents

Name Date
ANNUAL REPORT 2024-04-22
ANNUAL REPORT 2023-03-27
ANNUAL REPORT 2022-03-13
ANNUAL REPORT 2021-02-24
ANNUAL REPORT 2020-06-30
REINSTATEMENT 2019-02-18
ANNUAL REPORT 2017-03-20
ANNUAL REPORT 2016-04-20
ANNUAL REPORT 2015-04-10
ANNUAL REPORT 2014-04-22

Related by officers

Ginori, Elizabeth

CLEM INVESTMENTS I LLC

BAFITIS, HAROLD

NEWGENIX PHYSICIANS, INC. BAFITIS CONSULTING, INC. BAFITIS INTERNATIONAL INC MERIDIAN REGENERATIVE MEDICINE GROUP LLC PAROS PARTNERS, LLC SURGI-CENTER, LLC W&A LAND HOLDINGS, LLC

Related by address

4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458

DR. VALDES WEIGHT LOSS, LLC BAFITIS PLASTIC SURGERY P.A.

4601 MILITARY TRAIL, SUITE 208, JUPITER, FL 33458

DR. VALDES WEIGHT LOSS, LLC BAFITIS PLASTIC SURGERY P.A.

Date of last update: 30 Jan 2025

Sources: Florida Department of State

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