| Entity Name: | RAPHA VASCULAR SPECIALISTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Nov 2010 (14 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P10000095311 |
| FEI/EIN Number | 274006938 |
| Address: | 515 Missouri Avenue N., Largo, FL, 33770, US |
| Mail Address: | 515 Missouri Avenue N., Largo, FL, 33770, US |
| ZIP code: | 33770 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528363041 | 2011-01-13 | 2014-03-20 | 1619 HARDEN BLVD, LAKELAND, FL, 338031826, US | 1619 HARDEN BLVD, LAKELAND, FL, 338031826, US | |||||||||||||||||||||||
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| Phone | +1 863-577-8346 |
Authorized person
| Name | DR. OBINNA UCHENNA NWOBI |
| Role | PRESIDENT |
| Phone | 4076898793 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | ME 106633 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1912028853 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RAPHA VASCULAR SPECIALISTS, INC. 401(K) PLAN | 2012 | 274006938 | 2014-08-06 | RAPHA VASCULAR SPECIALISTS, INC. | 4 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-08-06 |
| Name of individual signing | OBINNA NWOBI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8635778346 |
| Plan sponsor’s address | 1619 HARDEN BLVD, LAKELAND, FL, 33803 |
Plan administrator’s name and address
| Administrator’s EIN | 274006938 |
| Plan administrator’s name | RAPHA VASCULAR SPECIALISTS, INC. |
| Plan administrator’s address | 1619 HARDEN BLVD, LAKELAND, FL, 33803 |
| Administrator’s telephone number | 8635778346 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-15 |
| Name of individual signing | OBINNA NWOBI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Stephen Steller J | Agent | 515 Missouri Avenue N., Largo, FL, 33770 |
| Name | Role | Address |
|---|---|---|
| Steller Jordan | Secretary | 515 Missouri Avenue N., Largo, FL, 33770 |
| Name | Role | Address |
|---|---|---|
| Stephen Steller J | President | 515 Missouri Avenue N., Largo, FL, 33770 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000096556 | TAMPA BAY VEIN INSTITUTE | EXPIRED | 2011-09-30 | 2016-12-31 | No data | 1619 HARDEN BOULEVARD, LAKELAND, FL, 33803 |
| G11000036096 | CENTRAL FLORIDA VEIN INSTITUTE | EXPIRED | 2011-04-12 | 2016-12-31 | No data | 1619 HARDEN BOULEVARD, LAKELAND, FL, 33803 |
| G10000109136 | POLK VEIN AND VASCULAR INSTITUTE | EXPIRED | 2010-11-30 | 2015-12-31 | No data | 4748 HIGHLANDS PLACE DRIVE, LAKELAND, FL, 33813 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-29 | 515 Missouri Avenue N., Largo, FL 33770 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-29 | 515 Missouri Avenue N., Largo, FL 33770 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-29 | 515 Missouri Avenue N., Largo, FL 33770 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-07-11 | Stephen, Steller J | No data |
| REINSTATEMENT | 2013-11-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000892561 | LAPSED | 12 CA 013465 | 13TH JUD CIR. HILLSBOROUGH CO. | 2014-08-21 | 2019-09-03 | $77275.35 | GALENCARE, INC, BRANDON REGIONAL HOSPITAL, ONE PARK PLAZA, NASHVILLE, TN 37203 |
| J14000021310 | TERMINATED | 1000000566734 | POLK | 2013-12-26 | 2024-01-03 | $ 1,667.41 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| J13000716846 | TERMINATED | 1000000487231 | POLK | 2013-04-03 | 2023-04-11 | $ 585.54 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| J13000332974 | TERMINATED | 2012SC-003732-0000-00 | CO CT POLK CO FL | 2013-01-22 | 2018-02-11 | $2560.78 | HALL COMMUNICATIONS, INC., 404 WEST LIME ST., LAKELAND, FL 33815 |
| J12000919111 | TERMINATED | 1000000425550 | POLK | 2012-11-26 | 2022-11-28 | $ 483.86 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| J12000828775 | LAPSED | 53-2012-CC-004366-WH | POLK COUNTY COURT | 2012-11-06 | 2017-11-08 | $15,862.44 | COVIDIEN F/D/B/A TYCO HEALTHCARE GROUP, LP, C/O WILLIAM M. LINDEMAN, P.A., P.O. BOX 3506, ORLANDO, FL 32802 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-29 |
| AMENDED ANNUAL REPORT | 2016-07-11 |
| ANNUAL REPORT | 2016-04-13 |
| ANNUAL REPORT | 2015-06-15 |
| ANNUAL REPORT | 2014-04-25 |
| ANNUAL REPORT | 2012-05-01 |
| ANNUAL REPORT | 2011-04-27 |
| Domestic Profit | 2010-11-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
