| Entity Name: | PAXTON MEDICAL MANAGEMENT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 13 Jul 2017 (8 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Nov 2019 (5 years ago) |
| Document Number: | P17000059983 |
| FEI/EIN Number | 84-2653866 |
| Address: | 8050 Seminole Blvd, Ste A, Seminole, FL 33772 |
| Mail Address: | 8050 Seminole Blvd, Ste A, Seminole, FL 33772 |
| ZIP code: | 33772 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588400691 | 2024-07-08 | 2024-07-08 | 1615 SUN CITY CENTER PLZ, SUN CITY CENTER, FL, 335735303, US | 1615 SUN CITY CENTER PLZ, SUN CITY CENTER, FL, 335735303, US | |||||||||||||
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| Phone | +1 813-894-7046 |
Authorized person
| Name | JEFFREY SCOTT GROVE |
| Role | OWNER |
| Phone | 7275889572 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAXTON MEDICAL MANAGEMENT, INC. 401(K) PLAN | 2023 | 842653866 | 2024-05-16 | PAXTON MEDICAL MANAGEMENT, INC. | 11 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-05-16 |
| Name of individual signing | KIMBERLY GROVE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7272752005 |
| Plan sponsor’s address | 8050 SEMINOLE BLVD., SUITE A, SEMINOLE, FL, 33772 |
Signature of
| Role | Plan administrator |
| Date | 2023-08-14 |
| Name of individual signing | KIMBERLY GROVE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7272752005 |
| Plan sponsor’s address | 8050 SEMINOLE BLVD., SUITE A, SEMINOLE, FL, 33772 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-12 |
| Name of individual signing | TERI MEREDITH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7272752005 |
| Plan sponsor’s address | 8050 SEMINOLE BLVD., SUITE A, SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| GROVE, JOHN | Agent | 8050 Seminole Blvd, Suite A, Seminole, FL 33772 |
| Name | Role | Address |
|---|---|---|
| Grove, Jeffrey S, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| TVEDTEN, TYRONE, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| DIBETTA, EUGENE, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| GROVE, JOHN T | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| DIBETTA, MICHELLE, M.D. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| CLARK, ANDREW, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| COOPER, CATHERINE, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| COOPER, CHRISTOPHER, D.O. | Director | 8050 Seminole Blvd, Suite A Seminole, FL 33772 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000057648 | SUN CITY SENIOR CARE | ACTIVE | 2024-05-01 | 2029-12-31 | No data | 1615 SUN CITY CENTER PLAZA, SUN CITY CENTER, FL, 33573 |
| G20000089357 | FAMILY DOCTORS OF NORTH PORT | ACTIVE | 2020-07-27 | 2025-12-31 | No data | PAXTON MEDICAL MANAGEMENT, 8050 SEMINOLE BLVD., SEMINOLE, FL, 33702 |
| G20000089372 | FAMILY DOCTORS OF ENGLEWOOD | ACTIVE | 2020-07-27 | 2025-12-31 | No data | 8050 SEMINOLE BLVD, SEMINOLE, FL, 33772 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-07 | 8050 Seminole Blvd, Suite A, Seminole, FL 33772 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-29 | 8050 Seminole Blvd, Ste A, Seminole, FL 33772 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-29 | 8050 Seminole Blvd, Ste A, Seminole, FL 33772 | No data |
| AMENDMENT | 2019-11-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-17 | GROVE, JOHN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-06-29 |
| Amendment | 2019-11-04 |
| Reg. Agent Change | 2019-10-17 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-16 |
| Domestic Profit | 2017-07-13 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
