| Entity Name: | DIXITKUMAR N MODI MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
DIXITKUMAR N MODI MD PA 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: | 05 Aug 2019 (6 years ago) |
| Document Number: | P19000061551 |
| FEI/EIN Number |
84-2682380
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3003 TRASONA DRIVE, MELBOURNE, FL, 32940, US |
| Mail Address: | 3003 TRASONA DRIVE, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962059493 | 2019-08-20 | 2024-02-23 | 3003 TRASONA DR, MELBOURNE, FL, 329407670, US | 4350 N ATLANTIC AVE, COCOA BEACH, FL, 329313656, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 321-613-5352 |
| Fax | 3216135356 |
| Phone | +1 334-327-9530 |
Authorized person
| Name | DR. DIXITKUMAR NAVINCHANDRA MODI |
| Role | OWNER |
| Phone | 3343279530 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104790300 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | ME133520 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DIXITKUMAR N. MODI, MD, PA 401(K) PLAN AND TRUST | 2022 | 842682380 | 2023-10-11 | DIXITKUMAR N. MODI, MD, PA | 5 | |||||||||||||
|
||||||||||||||||||
| DIXITKUMAR N. MODI, MD, PA 401(K) PLAN AND TRUST | 2021 | 842682380 | 2022-10-10 | DIXITKUMAR N. MODI, MD, PA | 5 | |||||||||||||
|
||||||||||||||||||
| Name | Role | Address |
|---|---|---|
| MODI DIXITKUMAR N | President | 3003 TRASONA DRIVE, MELBOURNE, FL, 32940 |
| MODI DIXITKUMAR N | Agent | 3003 TRASONA DRIVE, MELBOURNE, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000008321 | PREMIER MEDICAL CLINIC | ACTIVE | 2020-01-17 | 2025-12-31 | - | 3003 TRASONA DRIVE, MELBOURNE, FL, 32940 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-07-12 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-01-07 |
| Domestic Profit | 2019-08-05 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7949607202 | 2020-04-28 | 0455 | PPP | 4350 n atlantic avenue suite number 1, cocoa beach, FL, 32931 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 01 Apr 2025
Sources: Florida Department of State
