| Entity Name: | HAYES MEDICAL TRANSPORT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Jan 1997 (28 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Oct 2019 (5 years ago) |
| Document Number: | P97000007375 |
| FEI/EIN Number | 593433349 |
| Address: | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Mail Address: | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| ZIP code: | 34266 |
| County: | DeSoto |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568716694 | 2012-10-26 | 2012-10-26 | 3884 NE HIGHWAY 70, ARCADIA, FL, 342662813, US | 3884 NE HIGHWAY 70, ARCADIA, FL, 342662813, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 863-993-3733 |
| Fax | 8639933410 |
| Fax | 8639933140 |
Authorized person
| Name | DWAIN ROGER HAYES |
| Role | PRESIDENT/OWNER |
| Phone | 8639933733 |
Taxonomy
| Taxonomy Code | 343900000X - Non-emergency Medical Transport (VAN) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 430010600 |
| State | FL |
| Issuer | MEDICAID |
| Number | F592-201-909-002 |
| State | FL |
| Issuer | MEDICAID |
| Number | 410012300 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HAYES MEDICAL TRANSPORT INC. | 2012 | 593433349 | 2013-10-10 | HAYES MEDICAL TRANSPORT INC. | 36 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-10-10 |
| Name of individual signing | DWAIN HAYES |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-10-10 |
| Name of individual signing | DWAIN HAYES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621900 |
| Sponsor’s telephone number | 8639933733 |
| Plan sponsor’s address | 3884 NE HIGHWAY 70, ARCADIA, FL, 342662813 |
Plan administrator’s name and address
| Administrator’s EIN | 593433349 |
| Plan administrator’s name | HAYES MEDICAL TRANSPORT INC |
| Plan administrator’s address | 3884 NE HIGHWAY 70, ARCADIA, FL, 342662813 |
| Administrator’s telephone number | 8639933733 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-11 |
| Name of individual signing | HAYES MEDICAL TRANSPORT INC |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621900 |
| Sponsor’s telephone number | 8639933733 |
| Plan sponsor’s address | 3884 HWY 70 NE, ARCADIA, FL, 34266 |
Plan administrator’s name and address
| Administrator’s EIN | 593433349 |
| Plan administrator’s name | HAYES MEDICAL TRANSPORT, INC |
| Plan administrator’s address | 3884 HWY 70 NE, ARCADIA, FL, 34266 |
| Administrator’s telephone number | 8639933733 |
Signature of
| Role | Plan administrator |
| Date | 2011-06-23 |
| Name of individual signing | HAYES MEDICAL TRANSPORT, INC |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HAYES DWAIN | Agent | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Name | Role | Address |
|---|---|---|
| HAYES DWAIN | President | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Name | Role | Address |
|---|---|---|
| HAYES DWAIN | Secretary | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Name | Role | Address |
|---|---|---|
| HAYES DWAIN | Vice President | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Name | Role | Address |
|---|---|---|
| HAYES DWAIN | Treasurer | 3884 N.E. HIGHWAY 70, ARCADIA, FL, 34266 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-25 | HAYES, DWAIN | No data |
| REINSTATEMENT | 2011-03-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-03-29 |
| ANNUAL REPORT | 2020-05-04 |
| REINSTATEMENT | 2019-10-25 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-01-04 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-02-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
