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  5. BLACK BAG MEDICAL, INC.

BLACK BAG MEDICAL, INC.

Company Details

Entity Name: BLACK BAG MEDICAL, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 25 Aug 2006 (18 years ago)
Document Number: P06000111046
FEI/EIN Number 205438009
Address: 3840 Belfort Rd., STE. 102, JACKSONVILLE, FL, 32216, US
Mail Address: 4320 DEERWOOD LAKE PKWY, STE 101, PMB 321, JACKSONVILLE, FL, 32216, US
ZIP code: 32216
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1750440988 2006-12-06 2020-08-22 4320 DEERWOOD LAKE PKWY, SUITE 101, PMB 321, JACKSONVILLE, FL, 322161177, US 4320 DEERWOOD LAKE PKWY, SUITE 101, PMB 321, JACKSONVILLE, FL, 322161177, US

Contacts
Phone +1 904-371-4051
Fax 9048074839

Authorized person
Name BRIAN LAYNE STEPHENS
Role PRESIDENT
Phone 9043714051

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2023 205438009 2024-10-07 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101,PMB 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2022 205438009 2023-07-21 BLACK BAG MEDICAL, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2021 205438009 2022-06-02 BLACK BAG MEDICAL, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2020 205438009 2021-07-27 BLACK BAG MEDICAL, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2019 205438009 2020-07-01 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2018 205438009 2019-07-29 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2017 205438009 2018-09-11 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2016 205438009 2017-09-26 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2015 205438009 2016-08-15 BLACK BAG MEDICAL, INC. 4
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216
LITTLE BLACK BAG MEDICAL 401(K) PROFIT SHARING PLAN 2015 205438009 2016-09-15 BLACK BAG MEDICAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 9043714051
Plan sponsor’s address 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PM 13321, JACKSONVILLE, FL, 32216

Agent

Name Role Address
STEPHENS BRIAN Agent 4320 DEERWOOD LAKE PKWY, JACKSONVILLE, FL, 32216

President

Name Role Address
STEPHENS BRIAN President 4320 DEERWOOD LAKE PKWY STE 101, PMB 321, JACKSONVILLE, FL, 32216

Vice President

Name Role Address
STEPHENS BRIAN Vice President 4320 DEERWOOD LAKE PKWY STE 101, PMB 321, JACKSONVILLE, FL, 32216

Secretary

Name Role Address
STEPHENS BRIAN Secretary 4320 DEERWOOD LAKE PKWY STE 101, PMB 321, JACKSONVILLE, FL, 32216

Treasurer

Name Role Address
STEPHENS BRIAN Treasurer 4320 DEERWOOD LAKE PKWY STE 101, PMB 321, JACKSONVILLE, FL, 32216

Director

Name Role Address
STEPHENS BRIAN Director 4320 DEERWOOD LAKE PKWY STE 101, PMB 321, JACKSONVILLE, FL, 32216

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G07033900142 LITTLE BLACK BAG MEDICAL ACTIVE 2007-02-02 2027-12-31 No data 4320 DEERWOOD LAKE PARKWAY, SUITE 101, PMB 321, JACKSONVILLE, FL, 32216

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2015-01-09 3840 Belfort Rd., STE. 102, JACKSONVILLE, FL 32216 No data

Documents

Name Date
ANNUAL REPORT 2025-01-21
ANNUAL REPORT 2024-02-01
ANNUAL REPORT 2023-01-25
ANNUAL REPORT 2022-01-25
ANNUAL REPORT 2021-01-12
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-15

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STEPHENS BRIAN

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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