| Entity Name: | MOBILE PHYSICIAN SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
MOBILE PHYSICIAN SERVICES, 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: | 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
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 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 |
| 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 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN | 2022 | 204278037 | 2024-01-25 | MOBILE PHYSICIAN SERVICES, INC | 49 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN | 2021 | 204278037 | 2022-10-12 | MOBILE PHYSICIAN SERVICES, INC | 65 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN | 2020 | 204278037 | 2021-10-15 | MOBILE PHYSICIAN SERVICES, INC | 65 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, INC. 401(K) PLAN | 2019 | 204278037 | 2020-10-15 | MOBILE PHYSICIAN SERVICES, INC | 56 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, PA 401K PLAN | 2018 | 204278037 | 2019-05-30 | MOBILE PHYSICIAN SERVICES, INC | 44 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, PA 401K PLAN | 2017 | 204278037 | 2018-05-31 | MOBILE PHYSICIAN SERVICES, INC | 33 | |||||||||||||
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| MOBILE PHYSICIAN SERVICES, PA 401K PLAN | 2016 | 204278037 | 2017-05-18 | MOBILE PHYSICIAN SERVICES, INC | 27 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| WACKSMAN Jeffrey L | President | 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 346534935 |
| CHESTNUT BUSINESS SERVICES, LLC | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000046945 | MOBILE PHYSICIAN SERVICES | ACTIVE | 2016-05-10 | 2026-12-31 | - | 6804 CECELIA DRIVE, NEW PORT RICHEY, FL, 34653 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-12-03 | 311 PARK PLACE BOULEVARD, SUITE 300, CLEARWATER, FL 33759 | - |
| REGISTERED AGENT NAME CHANGED | 2016-11-29 | Chestnut Business Services, LLC | - |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2016-03-09 | MOBILE PHYSICIAN SERVICES, INC. | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-30 | 6804 CECELIA DRIVE, NEW PORT RICHEY, FL 34653-4935 | - |
| CHANGE OF MAILING ADDRESS | 2014-04-30 | 6804 CECELIA DRIVE, NEW PORT RICHEY, FL 34653-4935 | - |
| CANCEL ADM DISS/REV | 2007-09-21 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | - | - |
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5498607007 | 2020-04-05 | 0455 | PPP | 6804 CECELIA DR, NEW PORT RICHEY, FL, 34653-4935 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
