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COUNTRYSIDE NEUROLOGY, INC. - Florida Company Profile

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Company Details

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 (13 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
City: Palm Harbor
County: Pinellas
Place of Formation: FLORIDA

Key Officers & Management

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

National Provider Identifier

NPI Number:
1588834964

Authorized Person:

Name:
ARDESHIR KHADEMI-KEMANSHAHI
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
2084N0400X - Neurology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
200924147
Plan Year:
2023
Number Of Participants:
7
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
2
Sponsors Telephone Number:

Events

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 - -

Documents

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

USAspending Awards / Financial Assistance

Date:
2020-05-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
78275.00
Total Face Value Of Loan:
78275.00

Paycheck Protection Program

Jobs Reported:
8
Initial Approval Amount:
$78,275
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$78,275
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$78,922.65
Servicing Lender:
Bank of America, National Association
Use of Proceeds:
Payroll: $78,275

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Date of last update: 01 Jul 2025

Sources: Florida Department of State