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  5. LAKE PULMONARY CRITICAL CARE, P.A.

LAKE PULMONARY CRITICAL CARE, P.A.

Company Details

Entity Name: LAKE PULMONARY CRITICAL CARE, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 10 Jun 1996 (29 years ago)
Date of dissolution: 27 Sep 2019 (5 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2019 (5 years ago)
Document Number: P96000050227
FEI/EIN Number 593387104
Address: 1876 NIGHTINGALE LANE, TAVARES, FL, 32778, US
Mail Address: 1876 NIGHTINGALE LANE, TAVARES, FL, 32778, US
ZIP code: 32778
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1851372494 2005-11-10 2011-01-13 1876 NIGHTINGALE LN, TAVARES, FL, 327784359, US 1876 NIGHTINGALE LN, TAVARES, FL, 327784359, US

Contacts
Phone +1 352-742-4447
Fax 3527424448

Authorized person
Name MS. JESSICA LYNN BARBER
Role OPERATIONS MANAGER
Phone 3527424631

Taxonomy
Taxonomy Code 207RC0200X - Critical Care Medicine (Internal Medicine) Physician
Is Primary No
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
Is Primary Yes
Taxonomy Code 207RS0012X - Sleep Medicine (Internal Medicine) Physician
Is Primary No
Taxonomy Code 363LA2200X - Adult Health Nurse Practitioner
License Number ARNP9218919
State FL
Is Primary No
Taxonomy Code 364SC0200X - Critical Care Medicine Clinical Nurse Specialist
License Number ARNP9218919
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 254399100
State FL
Issuer BCBS PROVIDER NUMBER
Number 21518
State FL
Issuer MEDICARE RAILROAD
Number 2900100538
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
401(K) PROFIT SHARING PLAN & TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P. A. 2018 593387104 2019-09-23 LAKE PULMONARY CRITICAL CARE, P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3524558802
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 32778

Signature of
Role Plan administrator
Date 2019-09-23
Name of individual signing FRANCISCO J. MONTOYA, MD
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN & TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P. A. 2017 593387104 2018-06-11 LAKE PULMONARY CRITICAL CARE, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3524558802
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2018-06-11
Name of individual signing FRANCISCO J. MONTOYA, MD
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN & TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P. A. 2016 593387104 2017-07-19 LAKE PULMONARY CRITICAL CARE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2017-07-19
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-19
Name of individual signing LAKE PULMONARY CRITICAL CARE
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN & TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P. A. 2015 593387104 2016-10-05 LAKE PULMONARY CRITICAL CARE, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2016-10-05
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN & TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P. A. 2014 593387104 2015-05-04 LAKE PULMONARY CRITICAL CARE, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2015-05-04
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P.A. 2013 593387104 2014-04-09 LAKE PULMONARY CRITICAL CARE, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2014-04-09
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P.A. 2012 593387104 2013-03-25 LAKE PULMONARY CRITICAL CARE, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Signature of
Role Plan administrator
Date 2013-03-25
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P.A. 2011 593387104 2012-04-25 LAKE PULMONARY CRITICAL CARE, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Plan administrator’s name and address
Administrator’s EIN 593387104
Plan administrator’s name LAKE PULMONARY CRITICAL CARE, P.A.
Plan administrator’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359
Administrator’s telephone number 3527424447

Signature of
Role Plan administrator
Date 2012-04-25
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P.A. 2010 593387104 2011-05-31 LAKE PULMONARY CRITICAL CARE, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Plan administrator’s name and address
Administrator’s EIN 593387104
Plan administrator’s name LAKE PULMONARY CRITICAL CARE, P.A.
Plan administrator’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359
Administrator’s telephone number 3527424447

Signature of
Role Plan administrator
Date 2011-05-31
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature
401(K) PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF LAKE PULMONARY CRITICAL CARE, P.A. 2009 593387104 2010-08-25 LAKE PULMONARY CRITICAL CARE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3527424447
Plan sponsor’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359

Plan administrator’s name and address
Administrator’s EIN 593387104
Plan administrator’s name LAKE PULMONARY CRITICAL CARE, P.A.
Plan administrator’s address 1876 NIGHTINGALE LANE, TAVARES, FL, 327784359
Administrator’s telephone number 3527424447

Signature of
Role Plan administrator
Date 2010-08-25
Name of individual signing FRANK J. MONTOYA, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MONTOYA FRANK J. M Agent 1876 NIGHTINGALE LN., TAVARES, FL, 32778

President

Name Role Address
MONTOYA FRANK J. M President 1876 NIGHTINGALE LANE, TAVARES, FL

Treasurer

Name Role Address
MONTOYA FRANK J. M Treasurer 1876 NIGHTINGALE LANE, TAVARES, FL

Director

Name Role Address
MONTOYA FRANK J. M Director 1876 NIGHTINGALE LANE, TAVARES, FL
CIRELLI ROSEMARY AMD Director 1876 NIGHTINGALE LANE, TAVARES, FL, 32778

Vice President

Name Role Address
CIRELLI ROSEMARY AMD Vice President 1876 NIGHTINGALE LANE, TAVARES, FL, 32778

Secretary

Name Role Address
CIRELLI ROSEMARY AMD Secretary 1876 NIGHTINGALE LANE, TAVARES, FL, 32778

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09000160298 LAKESIDE SLEEP SUPPLIES EXPIRED 2009-09-29 2014-12-31 No data 1876 NIGHTINGALE LANE, TAVARES, FL, 32778

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
REGISTERED AGENT NAME CHANGED 2009-03-17 MONTOYA, FRANK J. MD No data
CHANGE OF PRINCIPAL ADDRESS 2004-01-26 1876 NIGHTINGALE LANE, TAVARES, FL 32778 No data
CHANGE OF MAILING ADDRESS 2004-01-26 1876 NIGHTINGALE LANE, TAVARES, FL 32778 No data
REGISTERED AGENT ADDRESS CHANGED 2004-01-26 1876 NIGHTINGALE LN., TAVARES, FL 32778 No data

Documents

Name Date
ANNUAL REPORT 2018-03-07
ANNUAL REPORT 2017-01-31
ANNUAL REPORT 2016-04-25
ANNUAL REPORT 2015-04-08
ANNUAL REPORT 2014-03-13
ANNUAL REPORT 2013-04-01
ANNUAL REPORT 2012-03-13
ANNUAL REPORT 2011-04-20
ANNUAL REPORT 2010-02-08
ANNUAL REPORT 2009-03-17

Related by officers

MONTOYA FRANK J. M

MONCI PROPERTIES, INC.

CIRELLI ROSEMARY AMD

MONCI PROPERTIES, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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