| Entity Name: | BLAINE PAYNE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
BLAINE PAYNE, 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: | 20 May 2014 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 19 Feb 2024 (a year ago) |
| Document Number: | P14000045295 |
| FEI/EIN Number |
47-1029812
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 180 NW HAYNES STREET, MADISON, FL, 32340, US |
| Mail Address: | P.O. BOX 185, MADISON, FL, 32341, US |
| ZIP code: | 32340 |
| County: | Madison |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770943409 | 2016-02-23 | 2016-06-30 | PO BOX 185, MADISON, FL, 323410185, US | 180 NW HAYNES ST, MADISON, FL, 323402010, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-973-1215 |
| Fax | 8669234163 |
Authorized person
| Name | TAMMEY REVELS |
| Role | BUSINESS MANAGER |
| Phone | 8509731215 |
Taxonomy
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| License Number | OS9255 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 37137 |
| Issuer | MEDICAID |
| Number | 272752800 |
| State | FL |
| Issuer | HUMANA |
| Number | HUMANA |
| Issuer | BCBS |
| Number | SXJQY |
| Name | Role | Address |
|---|---|---|
| PAYNE THERESA B | President | Post Office Box 185, Madison, FL, 32341 |
| PAYNE THERESA B | Treasurer | Post Office Box 185, Madison, FL, 32341 |
| Ball Angela M | Agent | 615 N. JEFFERSON ST., PERRY, FL, 32347 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-02-19 | - | - |
| REGISTERED AGENT NAME CHANGED | 2024-02-19 | Ball, Angela M. | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-02-16 | 180 NW HAYNES STREET, MADISON, FL 32340 | - |
| CHANGE OF MAILING ADDRESS | 2016-02-16 | 180 NW HAYNES STREET, MADISON, FL 32340 | - |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-02-19 |
| ANNUAL REPORT | 2022-03-24 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-28 |
| Domestic Profit | 2014-05-20 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4154387407 | 2020-05-08 | 0491 | PPP | 180 NW HAYNES ST, MADISON, FL, 32340-2010 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2936889010 | 2021-05-18 | 0491 | PPS | 180 NW Haynes St, Madison, FL, 32340-2010 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Mar 2025
Sources: Florida Department of State
