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  5. COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC.

COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC.

Company Details

Entity Name: COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 18 Dec 1998 (26 years ago)
Date of dissolution: 27 Sep 2024 (4 months ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2024 (4 months ago)
Document Number: P98000105554
FEI/EIN Number 593546644
Address: 2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL, 33763
Mail Address: 18222 US Hwy 41 N, Lutz, FL, 33549, US
ZIP code: 33763
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1194914978 2007-10-17 2007-10-17 2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL, 337631724, US 2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL, 337631724, US

Contacts
Phone +1 727-791-1411
Fax 7277911419

Authorized person
Name DR. SUSAN S ROPER
Role OWNER
Phone 7277911411

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number 46341
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2023 593546644 2024-06-05 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2022 593546644 2023-07-25 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2021 593546644 2022-07-06 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2020 593546644 2021-07-26 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2019 593546644 2020-07-28 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2018 593546644 2019-07-02 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2017 593546644 2018-07-27 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2016 593546644 2017-09-15 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2015 593546644 2016-10-11 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763
COUNTRYSIDE DERMATOLOGY & LASER CENTER, INC. PROFIT SHARING PLAN 2014 593546644 2015-09-01 COUNTRYSIDE DERMATOLOGY AND LASER CENTER, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 7277911411
Plan sponsor’s address 2467 ENTERPRISE ROAD, SUITE A, CLEARWATER, FL, 33763

Agent

Name Role Address
Ewanowski Rebecca Agent 18222 US Hwy 41 N, Lutz, FL, 33549

President

Name Role Address
Ewanowski Christopher President 18222 US Hwy 41 N, Lutz, FL, 33549

Secretary

Name Role Address
Ewanowski Rebecca Secretary 18222 US Hwy 41 N, Lutz, FL, 33549

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2024-09-27 No data No data
CHANGE OF MAILING ADDRESS 2022-03-02 2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL 33763 No data
REGISTERED AGENT NAME CHANGED 2022-03-02 Ewanowski, Rebecca No data
REGISTERED AGENT ADDRESS CHANGED 2022-03-02 18222 US Hwy 41 N, Lutz, FL 33549 No data
CHANGE OF PRINCIPAL ADDRESS 2009-03-25 2467 ENTERPRISE RD, SUITE A, CLEARWATER, FL 33763 No data

Documents

Name Date
ANNUAL REPORT 2023-02-15
ANNUAL REPORT 2022-03-02
Reg. Agent Change 2022-01-13
ANNUAL REPORT 2021-02-05
ANNUAL REPORT 2020-01-23
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-02-14
ANNUAL REPORT 2016-01-28
ANNUAL REPORT 2015-01-13

Related by officers

Ewanowski Rebecca

MCDONNELL DERMATOLOGY LLC EWAN HOLDCO, LLC CRWLCZ, LLC PRESTIGE DERMATOLOGY, INC. DERMATOLOGY SPECIALISTS OF NORTH FLORIDA, INC.

Related by address

18222 US Hwy 41 N, Lutz, FL, 33549, US

MCDONNELL DERMATOLOGY LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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