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  5. MRI ASSOCIATES OF PALM HARBOR, INC.

MRI ASSOCIATES OF PALM HARBOR, INC.

Company Details

Entity Name: MRI ASSOCIATES OF PALM HARBOR, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Feb 1995 (30 years ago)
Document Number: P95000016366
FEI/EIN Number 593299683
Address: 32615 US 19 NORTH, SUITE 4, PALM HARBOR, FL, 34684
Mail Address: 32615 US 19 NORTH, SUITE 4, PALM HARBOR, FL, 34684
ZIP code: 34684
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1568422996 2006-03-28 2024-09-04 32615 US HIGHWAY 19 N, SUITE 4, PALM HARBOR, FL, 346843176, US 32615 US HIGHWAY 19 N, SUITE 4, PALM HARBOR, FL, 346843176, US

Contacts
Phone +1 727-787-6900
Fax 7277872754
Fax 7272164789

Authorized person
Name AMANDA MAPLE
Role CHIEF ADMINISTRATIVE OFFICER
Phone 7277876900

Taxonomy
Taxonomy Code 261QR0200X - Radiology Clinic/Center
License Number HCC3787
State FL
Is Primary Yes

Other Provider Identifiers
Issuer AETNA
Number 974079
State FL
Issuer UNITED HEALTHCARE
Number 3405272
State FL
Issuer BC/BS
Number V2581
State FL
Issuer MEDICAID
Number 021547100
State FL
Issuer CIGNA
Number 5477442003
State FL
Issuer AVMED
Number 219693
State FL
Issuer RR MEDICARE
Number 630000865
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MRI ASSOCIATES OF PALM HARBOR 401(K) PROFIT SHARING PLAN & TRUST 2023 593299683 2024-04-22 MRI ASSOCIATES OF PALM HARBOR 147
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US 19 NORTH, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2024-04-22
Name of individual signing FRANK DIECIDUE
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PROFIT SHARING PLAN & TRUST 2020 593299683 2021-04-02 MRI ASSOCIATES OF PALM HARBOR 118
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US 19 NORTH, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2021-04-02
Name of individual signing FRANK DIECIDUE
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PROFIT SHARING PLAN & TRUST 2019 593299683 2020-06-22 MRI ASSOCIATES OF PALM HARBOR 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US 19 NORTH, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2020-06-22
Name of individual signing FRANK DIECIDUE
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401 K PROFIT SHARING PLAN TRUST 2018 593299683 2019-07-13 MRI ASSOCIATES OF PALM HARBOR 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US 19 NORTH, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2019-07-13
Name of individual signing FRANK DIECIDUE
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401 K PROFIT SHARING PLAN TRUST 2017 593299683 2018-10-15 MRI ASSOCIATES OF PALM HARBOR 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US 19 NORTH, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing MAGGIE SVENSSON
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PLAN 2015 593296683 2016-07-11 MRI ASSOCIATES OF PALM HARBOR 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621399
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176

Signature of
Role Plan administrator
Date 2016-07-11
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-11
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PLAN 2014 593296683 2015-07-29 MRI ASSOCIATES OF PALM HARBOR 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621399
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-29
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PLAN 2013 593296683 2014-06-13 MRI ASSOCIATES OF PALM HARBOR 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621399
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176

Signature of
Role Plan administrator
Date 2014-06-13
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-13
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PLAN 2012 593296683 2013-07-03 MRI ASSOCIATES OF PALM HARBOR 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621399
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176

Signature of
Role Plan administrator
Date 2013-07-03
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-03
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
MRI ASSOCIATES OF PALM HARBOR 401(K) PLAN 2011 593296683 2012-07-06 MRI ASSOCIATES OF PALM HARBOR 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621399
Sponsor’s telephone number 7277876900
Plan sponsor’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176

Plan administrator’s name and address
Administrator’s EIN 593296683
Plan administrator’s name MRI ASSOCIATES OF PALM HARBOR
Plan administrator’s address 32615 US HIGHWAY 19 N STE 4, PALM HARBOR, FL, 346843176
Administrator’s telephone number 7277876900

Signature of
Role Plan administrator
Date 2012-07-06
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-06
Name of individual signing RENEE KELLY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

Chief Executive Officer

Name Role Address
DIECIDUE FRANK J Chief Executive Officer 32615 US Highway N, Palm Harbor, FL, 34684
DAVIS GREGORY S Chief Executive Officer 32615 US Highway N, Palm Harbor, FL, 34684

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000085617 PALM HARBOR MRI ACTIVE 2012-08-30 2027-12-31 No data 32615 US HIGHWAY 19 N, SUITE 4, PALM HARBOR, FL, 34684

Events

Event Type Filed Date Value Description
REINSTATEMENT 1998-04-29 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1996-08-23 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J10000828258 TERMINATED 10-2361-CO-40 PINELLAS COUNTY COURT 2010-07-21 2015-08-09 $10,883.77 ULTRARAD CORPORATION, C/O SPRECHMAN & ASSOCIATES, P.A., 2775 SUNNY ISLES BLVD SUITE 100, NORTH MIAMI BEACH, FL 33160

Related by officers

DIECIDUE FRANK J

MRI ASSOCIATES OF LAKELAND LLC

DAVIS GREGORY S

DAVIS PROCESSING & CONSULTING, LLC DIAGNOSTIC RADIOLOGY SOLUTIONS, INCORPORATED FORMIDABLE INVESTMENT CO., INC. DEVRY FLORIDA LLC

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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