Menu
Search icon

MOBILE PHYSICIAN SERVICES, INC.

Company Details

Entity Name: MOBILE PHYSICIAN SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 09 Feb 2006 (19 years ago)
Last Event: AMENDED AND RESTATEDARTICLES/NAME CHANGE
Event Date Filed: 09 Mar 2016 (9 years ago)
Document Number: P06000020486
FEI/EIN Number 204278037
Address: 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653-4935, US
Mail Address: 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653-4935, US
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003002759 2007-09-17 2021-02-18 6804 CECELIA DR, NEW PORT RICHEY, FL, 346534935, US 6804 CECELIA DR, NEW PORT RICHEY, FL, 346534935, US

Contacts
Phone +1 855-232-0644
Fax 8885460488
Phone +1 727-232-0644

Authorized person
Name DR. RICHARD M WACKSMAN
Role MEDICAL DIRECTOR
Phone 8552320644

Taxonomy
Taxonomy Code 152W00000X - Optometrist
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME0086161
State FL
Is Primary No
Taxonomy Code 207RH0002X - Hospice and Palliative Medicine (Internal Medicine) Physician
Is Primary Yes
Taxonomy Code 2084P0805X - Geriatric Psychiatry Physician
Is Primary No
Taxonomy Code 213ES0103X - Foot & Ankle Surgery Podiatrist
Is Primary No
Taxonomy Code 363LA2200X - Adult Health Nurse Practitioner
Is Primary No

Other Provider Identifiers
Issuer PTAN
Number K9757
State FL
Issuer FL PTAN
Number K9757A
State FL
Issuer 1003002759
Number MEDICARE NPI
State FL
Issuer MEDICAID
Number 007870000
State FL
Issuer MEDICAID
Number 0404354
State OH
Issuer BCBS GROUP
Number 000MQ
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN 2023 204278037 2024-10-17 MOBILE PHYSICIAN SERVICES, INC 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN 2022 204278037 2024-01-25 MOBILE PHYSICIAN SERVICES, INC 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN 2021 204278037 2022-10-12 MOBILE PHYSICIAN SERVICES, INC 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN 2020 204278037 2021-10-15 MOBILE PHYSICIAN SERVICES, INC 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN 2019 204278037 2020-10-15 MOBILE PHYSICIAN SERVICES, INC 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 346534935
MOBILE PHYSICIAN SERVICES, PA 401K PLAN 2018 204278037 2019-05-30 MOBILE PHYSICIAN SERVICES, INC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, PA 401K PLAN 2017 204278037 2018-05-31 MOBILE PHYSICIAN SERVICES, INC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653
MOBILE PHYSICIAN SERVICES, PA 401K PLAN 2016 204278037 2017-05-18 MOBILE PHYSICIAN SERVICES, INC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-01
Business code 621111
Sponsor’s telephone number 7272320644
Plan sponsor’s address 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653

Agent

Name Role
CHESTNUT BUSINESS SERVICES, LLC Agent

President

Name Role Address
WACKSMAN Jeffrey L President 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 346534935

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000046945 MOBILE PHYSICIAN SERVICES ACTIVE 2016-05-10 2026-12-31 No data 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2024-12-03 311 PARK PLACE BOULEVARD, SUITE 300, CLEARWATER, FL 33759 No data
REGISTERED AGENT NAME CHANGED 2016-11-29 Chestnut Business Services, LLC No data
AMENDED AND RESTATEDARTICLES/NAME CHANGE 2016-03-09 MOBILE PHYSICIAN SERVICES, INC. No data
CHANGE OF PRINCIPAL ADDRESS 2014-04-30 6804 CECELIA DRIVE, NEW PORT RICHEY, FL 34653-4935 No data
CHANGE OF MAILING ADDRESS 2014-04-30 6804 CECELIA DRIVE, NEW PORT RICHEY, FL 34653-4935 No data
CANCEL ADM DISS/REV 2007-09-21 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2007-09-14 No data No data

Documents

Name Date
ANNUAL REPORT 2024-04-10
ANNUAL REPORT 2023-04-14
ANNUAL REPORT 2022-03-31
ANNUAL REPORT 2021-04-09
ANNUAL REPORT 2020-06-12
ANNUAL REPORT 2019-04-01
ANNUAL REPORT 2018-06-01
ANNUAL REPORT 2017-04-13
AMENDED ANNUAL REPORT 2016-11-29
ANNUAL REPORT 2016-04-26

Related by officers

WACKSMAN Jeffrey L

MOONSTONE REAL ESTATE HOLDINGS, LLC

Related by address

6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653-4935, US

MOONSTONE MEDICAL ENTERPRISES, LLC MOBILE PROFESSIONAL SERVICES, LLC

6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653-4935, US

MOONSTONE MEDICAL ENTERPRISES, LLC MOBILE PROFESSIONAL SERVICES, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated