| Entity Name: | THREE RIVERS MEDICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
THREE RIVERS MEDICAL, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 21 May 2003 (22 years ago) |
| Date of dissolution: | 22 May 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 May 2017 (8 years ago) |
| Document Number: | P03000056459 |
| FEI/EIN Number |
010783690
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 208 NW SUWANNEE AVENUE, BRANFORD, FL, 32008, US |
| Mail Address: | 29274 RIVER RUN ROAD, BRANFORD, FL, 32008, US |
| ZIP code: | 32008 |
| County: | Suwannee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710049671 | 2006-12-15 | 2010-02-04 | 208 SUWANNEE AVE NW, BRANFORD, FL, 320083265, US | 208 SUWANNEE AVE NW, BRANFORD, FL, 320083265, US | |||||||||||||||||||||||||
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| Phone | +1 386-935-1607 |
| Fax | 3869351667 |
Authorized person
| Name | MS. PEGGY L MALONEY |
| Role | PRACTICE MANAGER |
| Phone | 3869351607 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 2934442 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 303822000 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THREE RIVERS MEDICAL 401(K) P/S PLAN | 2012 | 010783690 | 2013-07-24 | THREE RIVERS MEDICAL | 8 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 010783690 |
| Plan administrator’s name | THREE RIVERS MEDICAL |
| Plan administrator’s address | 208 NW SUWANNEE AVE, BRANFORD, FL, 32008 |
| Administrator’s telephone number | 3869351607 |
Signature of
| Role | Plan administrator |
| Date | 2013-07-24 |
| Name of individual signing | RODNEY SCYPHERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2009-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3869351607 |
| Plan sponsor’s address | 208 NW SUWANNEE AVE, BRANFORD, FL, 32008 |
Plan administrator’s name and address
| Administrator’s EIN | 010783690 |
| Plan administrator’s name | THREE RIVERS MEDICAL |
| Plan administrator’s address | 208 NW SUWANNEE AVE, BRANFORD, FL, 32008 |
| Administrator’s telephone number | 3869351607 |
Signature of
| Role | Plan administrator |
| Date | 2012-09-15 |
| Name of individual signing | MARGARET MALONEY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2009-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3869351607 |
| Plan sponsor’s address | 208 NW SUWANNEE AVE, BRANFORD, FL, 32008 |
Plan administrator’s name and address
| Administrator’s EIN | 010783690 |
| Plan administrator’s name | THREE RIVERS MEDICAL |
| Plan administrator’s address | 208 NW SUWANNEE AVE, BRANFORD, FL, 32008 |
| Administrator’s telephone number | 3869351607 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-10 |
| Name of individual signing | MARGARET MALONEY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2009-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3869351607 |
| Plan sponsor’s address | 208 NW SUWANNEE AVE, BRANDFORD, FL, 32008 |
Plan administrator’s name and address
| Administrator’s EIN | 010783690 |
| Plan administrator’s name | THREE RIVERS MEDICAL |
| Plan administrator’s address | 208 NW SUWANNEE AVE, BRANDFORD, FL, 32008 |
| Administrator’s telephone number | 3869351607 |
Signature of
| Role | Plan administrator |
| Date | 2010-06-24 |
| Name of individual signing | MARGARET MALONEY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SCYPHERS RODNEY | Vice President | 29274 RIVER RUN ROAD, BRANFORD, FL, 32008 |
| SCYPHERS RODNEY | Agent | 29274 RIVER RUN ROAD, BRANFORD, FL, 32008 |
| Dr. Moise Anglade | President | 1483 South Federal Hwy, Boynton Beach, FL, 33435 |
| Dr. Michel Vandormael | Vice President | 9525 Blind Pass Rd, St. Pete Beach, FL, 33706 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-05-22 | - | - |
| REGISTERED AGENT NAME CHANGED | 2013-07-09 | SCYPHERS, RODNEY | - |
| AMENDMENT | 2007-06-22 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2005-01-11 | 208 NW SUWANNEE AVENUE, BRANFORD, FL 32008 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-08 |
| ANNUAL REPORT | 2016-04-23 |
| ANNUAL REPORT | 2015-01-09 |
| ANNUAL REPORT | 2014-04-15 |
| AMENDED ANNUAL REPORT | 2013-08-05 |
| ANNUAL REPORT | 2013-07-09 |
| ANNUAL REPORT | 2012-01-05 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-07-15 |
| ANNUAL REPORT | 2009-01-18 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
