Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Palm Beach
    4. ›
  4. 33470
    5. ›
  5. FAMILY MEDICINE OF PALMS WEST, INC.

FAMILY MEDICINE OF PALMS WEST, INC.

Company Details

Entity Name: FAMILY MEDICINE OF PALMS WEST, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 01 Jul 1996 (29 years ago)
Date of dissolution: 23 Sep 2016 (8 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2016 (8 years ago)
Document Number: P96000056603
FEI/EIN Number 65-0688891
Address: 13005 SOUTHERN BLVD., 213, LOXAHATCHEE, FL 33470
Mail Address: 13005 SOUTHERN BLVD., 213, LOXAHATCHEE, FL 33470
ZIP code: 33470
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1992983118 2008-02-11 2014-05-20 13005 SOUTHERN BLVD, SUITE 213, LOXAHATCHEE, FL, 334709206, US 13005 SOUTHERN BLVD, SUITE 213, LOXAHATCHEE, FL, 334709206, US

Contacts
Phone +1 561-790-4445
Fax 5617904235

Authorized person
Name NEAL R WARSHOFF
Role OWNER
Phone 5613138422

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number OS4914
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY MEDICINE OF PALMS WEST 401(K) PLAN 2011 650688891 2012-04-20 FAMILY MEDICINE OF PALMS WEST, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5617904445
Plan sponsor’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470

Plan administrator’s name and address
Administrator’s EIN 650688891
Plan administrator’s name FAMILY MEDICINE OF PALMS WEST, INC.
Plan administrator’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470
Administrator’s telephone number 5617904445

Signature of
Role Plan administrator
Date 2012-04-20
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-20
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE OF PALMS WEST 401(K) PLAN 2010 650688891 2012-03-23 FAMILY MEDICINE OF PALMS WEST, INC. 3
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5617904445
Plan sponsor’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470

Plan administrator’s name and address
Administrator’s EIN 650688891
Plan administrator’s name FAMILY MEDICINE OF PALMS WEST, INC.
Plan administrator’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470
Administrator’s telephone number 5617904445

Signature of
Role Plan administrator
Date 2012-03-23
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-03-23
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE OF PALMS WEST 401(K) PLAN 2010 650688891 2011-06-29 FAMILY MEDICINE OF PALMS WEST, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5617904445
Plan sponsor’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470

Plan administrator’s name and address
Administrator’s EIN 650688891
Plan administrator’s name FAMILY MEDICINE OF PALMS WEST, INC.
Plan administrator’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470
Administrator’s telephone number 5617904445

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-29
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE OF PALMS WEST 401(K) PLAN 2009 650688891 2010-09-08 FAMILY MEDICINE OF PALMS WEST, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5617904445
Plan sponsor’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470

Plan administrator’s name and address
Administrator’s EIN 650688891
Plan administrator’s name FAMILY MEDICINE OF PALMS WEST, INC.
Plan administrator’s address 13005 SOUTHERN BLVD., SUITE 213, LOXAHATCHEE, FL, 33470
Administrator’s telephone number 5617904445

Signature of
Role Plan administrator
Date 2010-09-08
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-08
Name of individual signing WILLIAM A. JACOBS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ASHI, SIMON Agent 2108 QUAIL ROOST DR., WESTON, FL 33327

Director

Name Role Address
ASHI, SIMON Director 2108 QUAIL ROOST DR., WESTON, FL 33327

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
REGISTERED AGENT ADDRESS CHANGED 2015-07-29 2108 QUAIL ROOST DR., WESTON, FL 33327 No data
AMENDMENT 2015-07-29 No data No data
REGISTERED AGENT NAME CHANGED 2015-07-29 ASHI, SIMON No data
AMENDMENT 2014-04-14 No data No data
AMENDMENT 2013-12-13 No data No data
AMENDMENT 2012-03-29 No data No data
AMENDMENT 2012-03-07 No data No data
REINSTATEMENT 2011-10-18 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2011-09-23 No data No data

Documents

Name Date
Amendment 2015-07-29
ANNUAL REPORT 2015-04-30
Amendment 2014-04-14
ANNUAL REPORT 2014-01-14
Amendment 2013-12-13
ANNUAL REPORT 2013-02-11
Amendment 2012-03-29
Amendment 2012-03-07
ANNUAL REPORT 2012-02-21
REINSTATEMENT 2011-10-18

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated