| Entity Name: | NEW SMYRNA BEACH FAMILY PRACTICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Oct 2004 (20 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P04000146685 |
| FEI/EIN Number | 202332325 |
| Address: | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| Mail Address: | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497909311 | 2008-11-05 | 2010-09-16 | 807 STATE ROAD 44, NEW SMYRNA BEACH, FL, 321687271, US | 807 STATE ROAD 44, NEW SMYRNA BEACH, FL, 321687271, US | |||||||||||||||
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| Phone | +1 386-428-5554 |
| Fax | 3864097971 |
Authorized person
| Name | GREGORY PAUL SAMANO |
| Role | PRESIDENT |
| Phone | 3864285554 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NEW SMYRNA BEACH FAMILY PRACTICE,INC. | 2018 | 202332325 | 2019-05-17 | NEW SMYRNA BEACH FAMILY PRACTICE,INC | 4 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2019-05-17 |
| Name of individual signing | MARGARET SAMANO |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-05-17 |
| Name of individual signing | MARGARET SAMANO |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4076205197 |
| Plan sponsor’s address | 101 WAYNE AVE, NEW SMYRNA BEACH, FL, 321686435 |
Signature of
| Role | Plan administrator |
| Date | 2019-01-11 |
| Name of individual signing | MARGARET SAMANO |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-01-11 |
| Name of individual signing | MARGARET SAMANO |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SAMANO GREGORY P | Agent | 807 STATE RD 44, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| SAMANO GREGORY P | President | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| SAMANO GREGORY P | Director | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| SAMANO MARGARET M | Director | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| SAMANO MARGARET M | Secretary | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| Name | Role | Address |
|---|---|---|
| SAMANO MARGARET M | Treasurer | 807 STATE RD. 44, NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CANCEL ADM DISS/REV | 2005-10-07 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2005-10-07 | SAMANO, GREGORY P | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-10-07 | 807 STATE RD 44, NEW SMYRNA BEACH, FL 32168 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-01-27 |
| ANNUAL REPORT | 2014-01-15 |
| ANNUAL REPORT | 2013-01-28 |
| ANNUAL REPORT | 2012-01-16 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-02-08 |
| ANNUAL REPORT | 2009-01-21 |
| ANNUAL REPORT | 2008-01-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
