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  5. PREMIER MEDICAL CLINIC, INC.

PREMIER MEDICAL CLINIC, INC.

Company Details

Entity Name: PREMIER MEDICAL CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Oct 1998 (26 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 16 Jan 2002 (23 years ago)
Document Number: P98000091663
FEI/EIN Number 593539240
Address: 315 E ASH STREET, PERRY, FL, 32347, US
Mail Address: 315 E ASH STREET, PERRY, FL, 32347, US
ZIP code: 32347
County: Taylor
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1518926799 2006-03-17 2020-08-22 315 E ASH ST, PERRY, FL, 323472029, US 315 E ASH ST, PERRY, FL, 323472029, US

Contacts
Phone +1 850-584-3278
Fax 8505848171

Authorized person
Name KHALIL M AFSH
Role OWNER
Phone 8505843278

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MCR
Number CB3685
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PREMIER MEDICAL CLINIC, INC. 401(K) PROFIT SHARING PLAN 2023 593539240 2024-09-12 PREMIER MEDICAL CLINIC, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347

Signature of
Role Plan administrator
Date 2024-09-12
Name of individual signing SHIRLEY HORNER
Valid signature Filed with authorized/valid electronic signature
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2022 593539240 2023-10-04 PREMIER MEDICAL CLINIC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2021 593539240 2022-10-01 PREMIER MEDICAL CLINIC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2020 593539240 2021-07-22 PREMIER MEDICAL CLINIC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2019 593539240 2020-09-28 PREMIER MEDICAL CLINIC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2018 593539240 2019-09-06 PREMIER MEDICAL CLINIC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2017 593539240 2018-10-04 PREMIER MEDICAL CLINIC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2016 593539240 2017-10-09 PREMIER MEDICAL CLINIC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2015 593539240 2016-10-10 PREMIER MEDICAL CLINIC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing TERESA FAULKENBERRY
Valid signature Filed with authorized/valid electronic signature
PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2014 593539240 2015-09-23 PREMIER MEDICAL CLINIC 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8505843278
Plan sponsor’s address 315 E. ASH STREET, PERRY, FL, 32347

Signature of
Role Plan administrator
Date 2015-09-23
Name of individual signing TERESA FAULKENBERRY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SOFI ABDUL HAMID Agent 315 E ASH STREET, PERRY, FL, 32347

President

Name Role Address
SOFI ABDUL HDR President 2131 Golden Eagle Dr W, Tallahassee, FL, 323124038

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G08207900231 PREMIER MEDICAL PEDIATRIC CLINIC EXPIRED 2008-07-25 2013-12-31 No data 315 EAST ASH ST, PERRY, FL, 32347

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-07-11 315 E ASH STREET, PERRY, FL 32347 No data
CHANGE OF MAILING ADDRESS 2023-07-11 315 E ASH STREET, PERRY, FL 32347 No data
REGISTERED AGENT NAME CHANGED 2023-07-11 SOFI, ABDUL HAMID No data
REGISTERED AGENT ADDRESS CHANGED 2023-07-11 315 E ASH STREET, PERRY, FL 32347 No data
NAME CHANGE AMENDMENT 2002-01-16 PREMIER MEDICAL CLINIC, INC. No data

Documents

Name Date
ANNUAL REPORT 2024-03-11
ANNUAL REPORT 2023-07-11
ANNUAL REPORT 2022-04-30
ANNUAL REPORT 2021-04-28
ANNUAL REPORT 2020-06-29
ANNUAL REPORT 2019-04-28
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-04-12
ANNUAL REPORT 2016-04-25
ANNUAL REPORT 2015-04-15

Related by officers

SOFI ABDUL HDR

PREMIER MEDICAL PEDIATRICS CLINIC, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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