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  5. BEACHES FAMILY MEDICINE, PA

BEACHES FAMILY MEDICINE, PA

Company Details

Entity Name: BEACHES FAMILY MEDICINE, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Jan 2005 (20 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Oct 2017 (7 years ago)
Document Number: P05000001358
FEI/EIN Number 202008461
Address: 228 6th Ave South, JACKSONVILLE BCH, FL, 32250, US
Mail Address: 14750 BEACH BLVD #33, JACKSONVILLE BCH, FL, 32250, US
ZIP code: 32250
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407986920 2007-03-06 2022-08-24 228 6TH AVE S, JACKSONVILLE BEACH, FL, 322506634, US 228 6TH AVE S, JACKSONVILLE BEACH, FL, 322506634, US

Contacts
Phone +1 904-247-1911
Fax 9042479736

Authorized person
Name DR. VAUGHN E DOBALIAN
Role PHYSICIAN AND OWNER
Phone 9042471911

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number OS0004709
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2023 202008461 2024-05-29 BEACHES FAMILY MEDICINE PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 228 6TH AVE S, JACKSONVILLE BEACH, FL, 32250

Signature of
Role Plan administrator
Date 2024-05-29
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2022 202008461 2023-05-11 BEACHES FAMILY MEDICINE PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 228 6TH AVE S, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 228 6TH AVE S, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2023-05-11
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2021 202008461 2022-07-05 BEACHES FAMILY MEDICINE PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2022-07-05
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2020 202008461 2021-07-19 BEACHES FAMILY MEDICINE PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2021-07-19
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2019 202008461 2020-07-07 BEACHES FAMILY MEDICINE PA 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2018 202008461 2019-06-04 BEACHES FAMILY MEDICINE PA 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2019-06-04
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2017 202008461 2018-03-29 BEACHES FAMILY MEDICINE PA 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2018-03-29
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2016 202008461 2017-04-07 BEACHES FAMILY MEDICINE PA 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2017-04-07
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2015 202008461 2016-07-26 BEACHES FAMILY MEDICINE PA 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2016-07-26
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature
BEACHES FAMILY MEDICINE PA 401(K) P/S PLAN 2014 202008461 2015-09-08 BEACHES FAMILY MEDICINE PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621112
Sponsor’s telephone number 9042471911
Plan sponsor’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250

Plan administrator’s name and address
Administrator’s EIN 202008461
Plan administrator’s name BEACHES FAMILY MEDICINE PA
Plan administrator’s address 465 3RD ST N, JACKSONVILLE BEACH, FL, 32250
Administrator’s telephone number 9042471911

Signature of
Role Plan administrator
Date 2015-09-08
Name of individual signing VAUGHN DOBALIAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DOBALIAN VAUGHN E Agent 228 6th ave South, JACKSONVILLE BCH, FL, 322504819

Director

Name Role Address
DOBALIAN VAUGHN E Director 228 SIXTH AVE SOUTH, JACKSONVILLE BEACH, FL, 32250

President

Name Role Address
DOBALIAN VAUGHN E President 228 SIXTH AVE SOUTH, JACKSONVILLE BEACH, FL, 32250

Secretary

Name Role Address
DOBALIAN VAUGHN E Secretary 228 SIXTH AVE SOUTH, JACKSONVILLE BEACH, FL, 32250

Treasurer

Name Role Address
DOBALIAN VAUGHN E Treasurer 228 SIXTH AVE SOUTH, JACKSONVILLE BEACH, FL, 32250

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-01-22 228 6th ave South, JACKSONVILLE BCH, FL 32250-4819 No data
CHANGE OF PRINCIPAL ADDRESS 2023-01-22 228 6th Ave South, JACKSONVILLE BCH, FL 32250 No data
CHANGE OF MAILING ADDRESS 2018-03-02 228 6th Ave South, JACKSONVILLE BCH, FL 32250 No data
REINSTATEMENT 2017-10-04 No data No data
REGISTERED AGENT NAME CHANGED 2017-10-04 DOBALIAN, VAUGHN E No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2017-09-22 No data No data
REINSTATEMENT 2011-10-03 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2011-09-23 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-01
ANNUAL REPORT 2023-01-22
ANNUAL REPORT 2022-01-25
ANNUAL REPORT 2021-01-28
ANNUAL REPORT 2020-03-19
ANNUAL REPORT 2019-02-05
ANNUAL REPORT 2018-03-02
REINSTATEMENT 2017-10-04
ANNUAL REPORT 2016-03-28
ANNUAL REPORT 2015-02-22

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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