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COUNTRYSIDE MEDICAL, P.A. - Florida Company Profile

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Company Details

Entity Name: COUNTRYSIDE MEDICAL, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

COUNTRYSIDE MEDICAL, 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: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 08 Sep 1997 (28 years ago)
Document Number: P97000077212
FEI/EIN Number 593465993

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 7860 SW 103RD ST RD, BLDG 100, STE 101, OCALA, FL, 34476, US
Mail Address: P.O. BOX 770719, OCALA, FL, 34477, US
ZIP code: 34476
City: Ocala
County: Marion
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
LEE KENNETH BDr. Director 9387 SW 72ND CT, OCALA, FL, 34476
GASSMAN ALAN S Agent 1245 COURT STREET SUITE 102, CLEARWATER, FL, 33756

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
DJELEP8TVKM8
UEI Expiration Date:
2024-12-11

Business Information

Doing Business As:
COUNTRYSIDE MEDICAL PA INC
Division Name:
COUNTRYSIDE MEDICAL, P.A.
Activation Date:
2023-12-14
Initial Registration Date:
2023-12-12

National Provider Identifier

NPI Number:
1275610362
Certification Date:
2023-09-01

Authorized Person:

Name:
DR. KENNETH BARUCH LEE
Role:
OWNER PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3528738116

Form 5500 Series

Employer Identification Number (EIN):
593465993
Plan Year:
2023
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
16
Sponsors Telephone Number:

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2006-04-13 7860 SW 103RD ST RD, BLDG 100, STE 101, OCALA, FL 34476 -
CHANGE OF MAILING ADDRESS 2005-04-20 7860 SW 103RD ST RD, BLDG 100, STE 101, OCALA, FL 34476 -

Documents

Name Date
ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2023-01-11
ANNUAL REPORT 2022-01-20
ANNUAL REPORT 2021-01-10
ANNUAL REPORT 2020-01-13
ANNUAL REPORT 2019-01-10
ANNUAL REPORT 2018-02-06
ANNUAL REPORT 2017-02-03
ANNUAL REPORT 2016-04-15
ANNUAL REPORT 2015-04-23

USAspending Awards / Financial Assistance

Date:
2020-04-15
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
168000.00
Total Face Value Of Loan:
168000.00

Paycheck Protection Program

Jobs Reported:
16
Initial Approval Amount:
$168,000
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$168,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$170,193.33
Servicing Lender:
SouthState Bank, National Association
Use of Proceeds:
Payroll: $168,000

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Date of last update: 01 Jul 2025

Sources: Florida Department of State