| Entity Name: | PRIMA VISTA WALK IN MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 04 Sep 1996 (28 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | P96000073141 |
| FEI/EIN Number | 65-0701549 |
| Address: | 784 S.E. PRIMA VISTA BOULEVARD, PORT ST. LUCIE, FL 34952 |
| Mail Address: | 784 S.E. PRIMA VISTA BOULEVARD, PORT ST. LUCIE, FL 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952423113 | 2007-04-06 | 2007-12-03 | 784 E PRIMA VISTA BLVD, PORT ST LUCIE, FL, 349522271, US | 784 E PRIMA VISTA BLVD, PORT ST LUCIE, FL, 349522271, US | |||||||||||||||||||||
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| Phone | +1 772-878-7311 |
| Fax | 7728787321 |
Authorized person
| Name | MISS SYLVIA A. MENDOZA |
| Role | PRESIDENT |
| Phone | 7728787311 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | GRP # FACILITY |
| Number | 72956 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRIMA VISTA WALK-IN MEDICAL CENTER, INC. PROFIT SHARING PLAN AND TRUST | 2009 | 650701549 | 2010-09-22 | PRIMA VISTA WALK IN MEDICAL CENTER, | 6 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650701549 |
| Plan administrator’s name | PRIMA VISTA WALK IN MEDICAL CENTER, |
| Plan administrator’s address | 144 S. SEWALLS POINT ROAD, STUART, FL, 34996 |
| Administrator’s telephone number | 7722192787 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-22 |
| Name of individual signing | SYLVIA MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-09-22 |
| Name of individual signing | SYLVIA MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MENDOZA, SYLVIA | Agent | 784 S.E. PRIMA VISTA BOULEVARD, PORT ST. LUCIE, FL 34952 |
| Name | Role | Address |
|---|---|---|
| MENDOZA, SYLVIA | Director | 784 SE PRIMA VISTA BLVD, PORT ST. LUCIE, FL |
| Name | Role | Address |
|---|---|---|
| MENDOZA, SYLVIA | President | 784 SE PRIMA VISTA BLVD, PORT ST. LUCIE, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-01-24 |
| ANNUAL REPORT | 2007-03-19 |
| ANNUAL REPORT | 2006-01-19 |
| ANNUAL REPORT | 2005-01-11 |
| ANNUAL REPORT | 2004-01-19 |
| ANNUAL REPORT | 2003-01-21 |
| ANNUAL REPORT | 2002-05-28 |
| ANNUAL REPORT | 2001-02-05 |
| ANNUAL REPORT | 2000-03-03 |
| ANNUAL REPORT | 1999-03-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
