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  5. LAWRENCE R. BLACK, D.O., P.A.

LAWRENCE R. BLACK, D.O., P.A. - Florida Company Profile

Company Details

Entity Name: LAWRENCE R. BLACK, D.O., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

LAWRENCE R. BLACK, D.O., P.A. 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: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 21 Dec 1995 (29 years ago)
Date of dissolution: 26 Sep 2014 (11 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 26 Sep 2014 (11 years ago)
Document Number: P95000096577
FEI/EIN Number 593350266

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 13691 METRO PARKWAY, SUITE 350, FORT MYERS, FL, 33912
Mail Address: 13691 METRO PARKWAY, SUITE 350, FORT MYERS, FL, 33912
ZIP code: 33912
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1619178654 2007-05-29 2013-04-03 13691 METRO PKWY, SUITE 350, FORT MYERS, FL, 339124327, US 13691 METRO PKWY, SUITE 350, FORT MYERS, FL, 339124327, US

Contacts
Phone +1 239-768-5313
Fax 2397689559

Authorized person
Name KAREN DESANTIS
Role OFFICE MANAGER
Phone 2397685313

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number OS5736
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2013 593350266 2014-01-27 LAWRENCE R. BLACK, D.O., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2397685313
Plan sponsor’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912

Signature of
Role Plan administrator
Date 2014-01-27
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-01-27
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2012 593350266 2013-06-07 LAWRENCE R. BLACK, D.O., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2397685313
Plan sponsor’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912

Signature of
Role Plan administrator
Date 2013-06-07
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-07
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2011 593350266 2012-07-30 LAWRENCE R. BLACK, D.O., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2397685313
Plan sponsor’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 593350266
Plan administrator’s name LAWRENCE R. BLACK, D.O., P.A.
Plan administrator’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912
Administrator’s telephone number 2397685313

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-30
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
LAWRENCE R. BLACK, D.O., P.A. MONEY PURCHASE PENSION PLAN 2010 593350266 2011-05-20 LAWRENCE R. BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2397685313
Plan sponsor’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 593350266
Plan administrator’s name LAWRENCE R. BLACK, D.O., P.A.
Plan administrator’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912
Administrator’s telephone number 2397685313

Signature of
Role Plan administrator
Date 2011-05-20
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-20
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
LAWRENCE R. BLACK, D.O., P.A. MONEY PURCHASE PENSION PLAN 2009 593350266 2010-10-04 LAWRENCE R. BLACK, D.O., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 2397685313
Plan sponsor’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 593350266
Plan administrator’s name LAWRENCE R. BLACK, D.O., P.A.
Plan administrator’s address 13691 METRO PARKWAY SOUTH,, SUITE 350, FORT MYERS, FL, 33912
Administrator’s telephone number 2397685313

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-04
Name of individual signing LAWRENCE R. BLACK, D.O.
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
BLACK LAWRENCE R Director 13691 METRO PKWY S SUITE 350, FT MYERS, FL, 33912
BLACK LAWRENCE R President 13691 METRO PKWY S SUITE 350, FT MYERS, FL, 33912
BLACK LAWRENCE R Secretary 13691 METRO PKWY S SUITE 350, FT MYERS, FL, 33912
BLACK LAWRENCE R Treasurer 13691 METRO PKWY S SUITE 350, FT MYERS, FL, 33912
BLACK LAWRENCE R Agent 13691 METRO PKWY S, FT MYERS, FL, 33912

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 - -
CHANGE OF MAILING ADDRESS 2011-01-28 13691 METRO PARKWAY, SUITE 350, FORT MYERS, FL 33912 -
REINSTATEMENT 2011-01-28 - -
CHANGE OF PRINCIPAL ADDRESS 2011-01-28 13691 METRO PARKWAY, SUITE 350, FORT MYERS, FL 33912 -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2008-09-26 - -
CANCEL ADM DISS/REV 2006-04-24 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2005-09-16 - -

Documents

Name Date
ANNUAL REPORT 2013-02-07
ANNUAL REPORT 2012-03-21
REINSTATEMENT 2011-01-28
ANNUAL REPORT 2007-07-10
REINSTATEMENT 2006-04-24
ANNUAL REPORT 2004-03-29
ANNUAL REPORT 2003-01-29
ANNUAL REPORT 2002-01-21
ANNUAL REPORT 2001-01-29
ANNUAL REPORT 2000-02-04

Companies related by officers

No other companies in our directory share the same officers as LAWRENCE R. BLACK, D.O., P.A.

Companies related by address

No other companies in our directory share the same address as LAWRENCE R. BLACK, D.O., P.A.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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