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  5. RANDALL HUMPHREYS, P.A.

RANDALL HUMPHREYS, P.A.

Company Details

Entity Name: RANDALL HUMPHREYS, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 30 Dec 1994 (30 years ago)
Document Number: P95000000018
FEI/EIN Number 593289114
Address: 2401 ST ANDREWS BLVD, PANAMA CITY, FL, 32405, US
Mail Address: 2401 ST ANDREWS BLVD, PANAMA CITY, FL, 32405, US
ZIP code: 32405
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548372873 2006-08-31 2010-08-02 2401 SAINT ANDREWS BLVD, PANAMA CITY, FL, 324052170, US 2401 SAINT ANDREWS BLVD, PANAMA CITY, FL, 324052170, US

Contacts
Phone +1 850-785-2717
Fax 8507852301

Authorized person
Name DR. RANDALL F HUMPHREYS
Role PRESIDENT
Phone 8507852717

Taxonomy
Taxonomy Code 207K00000X - Allergy & Immunology Physician
License Number ME59222
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 052572300
State FL
Issuer BCBS OF FLORIDA
Number 12097
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2021 593289114 2022-05-05 RANDALL HUMPHREYS, P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2022-05-05
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2021 593289114 2022-12-15 RANDALL HUMPHREYS, P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2022-12-15
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2020 593289114 2021-05-24 RANDALL HUMPHREYS, P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2021-05-24
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2019 593289114 2020-06-29 RANDALL HUMPHREYS, P.A. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2020-06-29
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2018 593289114 2019-05-20 RANDALL HUMPHREYS, P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2019-05-20
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2017 593289114 2018-07-16 RANDALL HUMPHREYS, P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2016 593289114 2017-04-11 RANDALL HUMPHREYS, P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2017-04-11
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, PA MONEY PURCHASE PENSION PLAN 2015 593289114 2016-05-25 RANDALL HUMPHREYS, P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, P. A. 401(K) PLAN 2015 593289114 2016-05-25 RANDALL HUMPHREYS, P.A. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature
RANDALL HUMPHREYS, PA MONEY PURCHASE PENSION PLAN 2014 593289114 2015-03-26 RANDALL HUMPHREYS, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8507852717
Plan sponsor’s address 2401 ST. ANDREWS BLVD., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2015-03-26
Name of individual signing RANDALL HUMPHREYS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HUMPHREYS RANDALL Agent 2401 ST ANDREWS BLVD, PANAMA CITY, FL, 32405

President

Name Role Address
HUMPHREYS RANDALL M President 2401 ST ANDREWS BLVD, PANAMA CITY, FL, 32405

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000147421 ALLERVIE HEALTH ACTIVE 2022-12-01 2027-12-31 No data 2401 ST ANDREWS BLVD, PANAMA CITY, FL, 32405

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2002-03-07 2401 ST ANDREWS BLVD, PANAMA CITY, FL 32405 No data
CHANGE OF MAILING ADDRESS 2002-03-07 2401 ST ANDREWS BLVD, PANAMA CITY, FL 32405 No data
REGISTERED AGENT ADDRESS CHANGED 2002-03-07 2401 ST ANDREWS BLVD, PANAMA CITY, FL 32405 No data

Documents

Name Date
ANNUAL REPORT 2024-03-20
ANNUAL REPORT 2023-03-31
ANNUAL REPORT 2022-05-02
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-01-10
ANNUAL REPORT 2019-03-08
ANNUAL REPORT 2018-01-26
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-01-14
ANNUAL REPORT 2015-01-13

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4080657107 2020-04-12 0491 PPP 2401 SAINT ANDREWS BLVD, PANAMA CITY, FL, 32405-2170
Loan Status Date 2021-01-26
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 55325
Loan Approval Amount (current) 55325
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39848
Servicing Lender Name Cadence Bank
Servicing Lender Address 201 S Spring St, TUPELO, MS, 38804-4811
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PANAMA CITY, BAY, FL, 32405-2170
Project Congressional District FL-02
Number of Employees 7
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 39848
Originating Lender Name Cadence Bank
Originating Lender Address TUPELO, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 55680
Forgiveness Paid Date 2020-12-10

Related by officers

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Related by address

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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