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  5. CISCA PULMONARY CRITICAL CARE , INC.

CISCA PULMONARY CRITICAL CARE , INC.

Company Details

Entity Name: CISCA PULMONARY CRITICAL CARE , INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 13 Aug 2012 (12 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 10 Sep 2021 (3 years ago)
Document Number: P12000069650
FEI/EIN Number 46-0790416
Address: 1361 13TH AVE. S,, JACKSONVILLE BEACH, FL, 32250, US
Mail Address: 1361 13TH AVE. S,, JACKSONVILLE BEACH, FL, 32250, US
ZIP code: 32250
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1629326285 2012-08-29 2023-11-17 1361 13TH AVE S STE 245, JACKSONVILLE BEACH, FL, 322503238, US 1361 13TH AVE S STE 245, JACKSONVILLE BEACH, FL, 32250, US

Contacts
Phone +1 904-396-0300
Fax 9043963039
Phone +1 904-493-7174
Fax 9046940696

Authorized person
Name KATIE YEOMANS
Role PRACTICE ADMINISTRATOR
Phone 9549354453

Taxonomy
Taxonomy Code 207RC0200X - Critical Care Medicine (Internal Medicine) Physician
Is Primary No
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 009836500
State FL
Issuer MEDICAID
Number 2757133-00
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2022 460790416 2023-10-12 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2019 460790416 2020-10-15 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2018 460790416 2019-10-15 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250
CISCA PULMONARY CRITICAL CARE, INC. DEFINED BENEFIT PENSION PLAN 2016 460790416 2018-01-29 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250

Signature of
Role Plan administrator
Date 2018-01-29
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-01-29
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2016 460790416 2018-01-29 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250

Signature of
Role Plan administrator
Date 2018-01-29
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-01-29
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. DEFINED BENEFIT PENSION PLAN 2015 460790416 2016-10-19 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 1361 13TH AVE SOUTH, SUITE 245, JACKSONVILLE BEACH, FL, 32250

Signature of
Role Plan administrator
Date 2016-10-19
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-19
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2015 460790416 2016-10-19 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 13500 SUTTON PARK DR SOUTH, STE 601, JACKSONVILLE, FL, 32224

Signature of
Role Plan administrator
Date 2016-10-19
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-19
Name of individual signing ALEXIS VAZQUEZ
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2014 460790416 2015-07-08 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 13500 SUTTON PARK DR SOUTH, STE 601, JACKSONVILLE, FL, 32224

Signature of
Role Plan administrator
Date 2015-07-08
Name of individual signing KIM WILMOTH
Valid signature Filed with authorized/valid electronic signature
CISCA PULMONARY CRITICAL CARE, INC. 401(K) PROFIT SHARING PLAN 2013 460790416 2014-07-07 CISCA PULMONARY CRITICAL CARE, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3056079446
Plan sponsor’s address 13500 SUTTON PARK DR SOUTH, STE 601, JACKSONVILLE, FL, 32224

Signature of
Role Plan administrator
Date 2014-07-07
Name of individual signing KIM WILMOTH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Vazquez Alexis A Agent 1361 13TH AVE. S,, JACKSONVILLE BEACH, FL, 32250

President

Name Role Address
VAZQUEZ ALEXIS President 1361 13TH AVE. S,, JACKSONVILLE BEACH, FL, 32250

Admi

Name Role Address
Yeomans Katie Admi 1361 13TH AVE. S,, JACKSONVILLE BEACH, FL, 32250

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2022-07-15 1361 13TH AVE. S,, SUITE 245, JACKSONVILLE BEACH, FL 32250 No data
REINSTATEMENT 2021-09-10 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
CHANGE OF PRINCIPAL ADDRESS 2017-12-05 1361 13TH AVE. S,, SUITE 245, JACKSONVILLE BEACH, FL 32250 No data
CHANGE OF MAILING ADDRESS 2017-12-05 1361 13TH AVE. S,, SUITE 245, JACKSONVILLE BEACH, FL 32250 No data
REGISTERED AGENT NAME CHANGED 2016-03-28 Vazquez, Alexis A No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J21000443097 TERMINATED 1000000899269 DUVAL 2021-08-26 2031-09-01 $ 580.60 STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825

Documents

Name Date
ANNUAL REPORT 2024-03-04
ANNUAL REPORT 2023-03-22
ANNUAL REPORT 2022-07-15
REINSTATEMENT 2021-09-10
ANNUAL REPORT 2019-02-18
ANNUAL REPORT 2018-03-30
ANNUAL REPORT 2017-05-02
ANNUAL REPORT 2016-03-28
ANNUAL REPORT 2015-01-12
ANNUAL REPORT 2014-04-21

Related by officers

VAZQUEZ ALEXIS

ALEXIS GENERAL REPAIRS CORP. S.M.B BROADBAND, INC., 1811 SOLUTIONS LLC QUICK CARE CLINIC LLC AV AVENTURA INVESTMENTS LLC BE BOUNDLESS APPAREL LLC KRISTAL CLEANING INC. SECTOR FIVE ORLANDO LLC ALEXIS MARIE PHOTOGRAPHY AND FILM LLC PREMIER SOLUTIONS USA, INC.

Yeomans Katie

CISCA MANAGEMENT, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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