Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Leon
    4. ›
  4. 32308
    5. ›
  5. SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA

SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA

Company Details

Entity Name: SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 22 Aug 2006 (18 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 10 Oct 2011 (13 years ago)
Document Number: P06000110062
FEI/EIN Number 205417408
Address: 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308
Mail Address: 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308
ZIP code: 32308
County: Leon
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982747838 2007-02-14 2011-10-26 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 323085359, US 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 323085359, US

Contacts
Phone +1 850-942-2299
Fax 8509420322

Authorized person
Name DR. PHILBERT J FORD
Role PHYSICIAN
Phone 8509422299

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME91513
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 275226300
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2023 205417408 2024-10-10 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2022 205417408 2023-11-01 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHAR 2021 205417408 2022-09-26 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHAR 2020 205417408 2021-10-08 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHAR 2019 205417408 2020-10-10 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHAR 2018 205417408 2019-08-19 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2017 205417408 2018-09-17 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2016 205417408 2017-10-12 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2015 205417408 2016-09-28 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2016-09-28
Name of individual signing TERESA FAULKENBERRY
Valid signature Filed with authorized/valid electronic signature
SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 401(K) PROFIT SHARING PLAN 2014 205417408 2015-09-30 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509422299
Plan sponsor’s address 2009 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing TERESA FAULKENBERRY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FORD PHILBERT J Agent 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308

President

Name Role Address
FORD PHILBERT J President 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308

Secretary

Name Role Address
FORD PHILBERT J Secretary 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308

Treasurer

Name Role Address
FORD PHILBERT J Treasurer 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308

Director

Name Role Address
FORD PHILBERT J Director 2009 MICCOSUKEE RD, TALLAHASSEE, FL, 32308

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2011-10-10 SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA No data
REGISTERED AGENT ADDRESS CHANGED 2011-01-04 2009 MICCOSUKEE RD, TALLAHASSEE, FL 32308 No data
AMENDMENT AND NAME CHANGE 2009-12-18 PHILBERT J. FORD, M.D., P.A. No data
CHANGE OF PRINCIPAL ADDRESS 2009-12-18 2009 MICCOSUKEE RD, TALLAHASSEE, FL 32308 No data
CHANGE OF MAILING ADDRESS 2009-12-18 2009 MICCOSUKEE RD, TALLAHASSEE, FL 32308 No data
REGISTERED AGENT NAME CHANGED 2009-06-03 FORD, PHILBERT JPSTD No data

Documents

Name Date
ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-02-21
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-03-26
ANNUAL REPORT 2018-01-10
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-01-13
ANNUAL REPORT 2015-01-07

Related by officers

FORD PHILBERT J

PROSALUS RESEARCH GROUP, LLC ANALYX RESEARCH CONSORTIUM, LLC

Related by address

No related companies by address

Date of last update: 01 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