| Entity Name: | COUNTRYSIDE NEUROLOGY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
COUNTRYSIDE NEUROLOGY, 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 25 Mar 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 30 Dec 2012 (12 years ago) |
| Document Number: | P04000053152 |
| FEI/EIN Number |
200924147
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 2595 Tampa Road, Palm Harbor, FL, 34684, US |
| Mail Address: | 10021 Bentley Way, Tampa, FL, 33626, US |
| ZIP code: | 34684 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588834964 | 2008-03-03 | 2008-03-03 | 2349 SUNSET PT RD SUITE 403, CLEARWATER, FL, 34682, US | 2349 SUNSET POINT RD STE 403, CLEARWATER, FL, 337651439, US | |||||||||||||||||
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| Phone | +1 727-712-1567 |
Authorized person
| Name | ARDESHIR KHADEMI-KEMANSHAHI |
| Role | PRESIDENT |
| Phone | 7277121567 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME80114 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COUNTRYSIDE NEUROLOGY, INC 401K PLAN | 2023 | 200924147 | 2024-08-01 | COUNTRYSIDE NEUROLOGY, INC | 7 | |||||||||||||||||||||||
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| COUNTRYSIDE NEUROLOGY, INC 401K PLAN | 2022 | 200924147 | 2023-09-20 | COUNTRYSIDE NEUROLOGY, INC | 4 | |||||||||||||||||||||||
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| COUNTRYSIDE NEUROLOGY, INC 401K PLAN | 2021 | 200924147 | 2022-10-11 | COUNTRYSIDE NEUROLOGY, INC | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-10-11 |
| Name of individual signing | ARDESHIR KHADEMI-KERMANSHAHI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7274631221 |
| Plan sponsor’s address | 36181 EAST LAKE ROAD 268, PALM HARBOR, FL, 34685 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-09 |
| Name of individual signing | ARDESHIR KHADEMI-KERMANSHAHI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7274631221 |
| Plan sponsor’s address | 36181 EAST LAKE ROAD 268, PALM HARBOR, FL, 34685 |
Signature of
| Role | Plan administrator |
| Date | 2020-08-31 |
| Name of individual signing | ARDESHIR KHADEMI-KERMANSHAHI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7274631221 |
| Plan sponsor’s address | 36181 EAST LAKE ROAD 268, PALM HARBOR, FL, 34685 |
Signature of
| Role | Plan administrator |
| Date | 2019-09-11 |
| Name of individual signing | ARDESHIR KHADEMI-KERMANSHAHI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| KHADEMI-KERMANSHAHI ARDESHIR | President | 9806 New Parke Road, Tampa, FL, 33626 |
| KHADEMI-KERMANSHAHI ARDESHIR | Secretary | 9806 New Parke Road, Tampa, FL, 33626 |
| KHADEMI-KERMANSHAHI ARDESHIR | Treasurer | 9806 New Parke Road, Tampa, FL, 33626 |
| KHADEMI-KERMANSHAHI ARDESHIR | Director | 9806 New Parke Road, Tampa, FL, 33626 |
| KHADEMI-KERMANSHAHI ARDESHIR | Agent | 2595 Tampa Road, Palm Harbor, FL, 34684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-10 | 2595 Tampa Road, Suite V & W, Palm Harbor, FL 34684 | - |
| CHANGE OF MAILING ADDRESS | 2022-11-10 | 2595 Tampa Road, Suite V & W, Palm Harbor, FL 34684 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-26 | 2595 Tampa Road, Suite V & W, Palm Harbor, FL 34684 | - |
| AMENDMENT | 2012-12-30 | - | - |
| REINSTATEMENT | 2011-01-31 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| CANCEL ADM DISS/REV | 2006-10-06 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-02-01 |
| AMENDED ANNUAL REPORT | 2022-11-10 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-04-13 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-04-04 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6095657708 | 2020-05-01 | 0455 | PPP | 1840 MEASE DR STE 407B, SAFETY HARBOR, FL, 34695-6603 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 May 2025
Sources: Florida Department of State
