| Entity Name: | EXCEPTIONAL URGENT CARE CENTER I, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Feb 2004 (21 years ago) |
| Document Number: | P04000032958 |
| FEI/EIN Number | 200760917 |
| Address: | 13767 US HWY 441, Lady Lake, FL, 32159, US |
| Mail Address: | 13767 US HWY 441, Lady Lake, FL, 32159, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700898467 | 2006-08-12 | 2009-01-15 | 11950 COUNTY ROAD 101, SUITE #101, THE VILLAGES, FL, 321629332, US | 11950 COUNTY ROAD 101, SUITE #101, THE VILLAGES, FL, 321629332, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 352-391-5200 |
| Fax | 3523915903 |
Authorized person
| Name | DR. JOHN JOSEPH IM |
| Role | DIRECTOR |
| Phone | 3523915200 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | OS8729 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265844500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EXCEPTIONAL URGENT CARE 401(K) PLAN | 2023 | 200760917 | 2024-05-02 | EXCEPTIONAL URGENT CARE CENTER I | 3 | |||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-02 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3523915200 |
| Plan sponsor’s address | 13767 N US HIGHWAY 441, LADY LAKE, FL, 32159 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-30 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| IM JOHN J | Agent | 7722 SE 12th CIRCLE, OCALA, FL, 34480 |
| Name | Role | Address |
|---|---|---|
| IM JOHN J | Director | 13767 US HWY 441, Lady Lake, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-03-14 | IM, JOHN J. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-14 | 7722 SE 12th CIRCLE, OCALA, FL 34480 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-08-01 | 13767 US HWY 441, Lady Lake, FL 32159 | No data |
| CHANGE OF MAILING ADDRESS | 2019-08-01 | 13767 US HWY 441, Lady Lake, FL 32159 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J16000256119 | LAPSED | 2013-CA-1105 | CIRCUIT COURT - SUMTER COUNTY | 2016-03-22 | 2021-04-18 | $176,396.81 | PINEDA REO, LLC, 99 HIGH STREET, 7TH FLOOR, ATTN: JULIE MCINTOSH, BOSTON, MA 2110 |
| J11000651997 | LAPSED | 11-CA-702 | 5TH JUDICIAL CIRCUIT | 2011-10-03 | 2016-10-06 | $213,123.35 | WELLS FARGO EQUIPMENT FINANCE, INC., 733 MARQUETTE AVENUE, SUITE 700, MINNEAPOLIS, MN 55402 |
| J11000501093 | LAPSED | 2010 CA 000327 | SUMTER COUNTY | 2011-05-25 | 2016-08-08 | $69,689.93 | HITACHI CAPITAL AMERICA CORP., 800 CONNECTICUT AVENUE, NORWALK, CT 06854 |
| J11000002456 | LAPSED | 42-2010-CA-001801 | CIRCUIT COURT MARION COUNTY | 2010-12-20 | 2016-01-04 | $62,798.60 | REGIONS BANK, 1900 FIFTH AVENUE NORTH, BIRMINGHAM AL 35203 |
| J11000002381 | LAPSED | 42-2010-CA-001801 | CIRCUIT COURT MARION COUNTY | 2010-12-20 | 2016-01-04 | $65,000 | REGIONS BANK, 1900 FIFTH AVENUE NORTH, TAMPA, FL 33602 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-10 |
| AMENDED ANNUAL REPORT | 2019-08-01 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-04-07 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-01-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
