| Entity Name: | KIDSVILLE PEDIATRICS I, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
KIDSVILLE PEDIATRICS I, 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: | 04 Jan 1999 (26 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 22 Jul 2011 (14 years ago) |
| Document Number: | P99000001057 |
| FEI/EIN Number |
593551592
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | P.O. BOX 452223, KISSIMMEE, FL, 34745 |
| Address: | 2201 NORTH BLVD. WEST, DAVENPORT, FL, 33837 |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780658294 | 2006-02-14 | 2022-10-07 | 2201 NORTH BLVD W, DAVENPORT, FL, 338378990, US | 2201 NORTH BLVD W, DAVENPORT, FL, 338378990, US | |||||||||||||||||||||||||||||||
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| Phone | +1 863-419-0688 |
| Fax | 8634199547 |
Authorized person
| Name | MR. VICTOR M. PANTOJA JR. |
| Role | ADMINISTRATOR |
| Phone | 8634190688 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME-0074421 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265713900 |
| State | FL |
| Issuer | MEDICARE |
| Number | GV270A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ FRANCELIS IDr. | Chief Executive Officer | PO BOX 452223, KISSIMMEE, FL, 34745 |
| PANTOJA VICTOR MJr. | President | P.O. BOX 452223, KISSIMMEE, FL, 34745 |
| PANTOJA VICTOR MJr. | Agent | 2201 North Blvd West, Devenport, FL, 33837 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-27 | 2201 North Blvd West, Devenport, FL 33837 | - |
| REGISTERED AGENT NAME CHANGED | 2013-03-03 | PANTOJA, VICTOR M., Jr. | - |
| AMENDMENT | 2011-07-22 | - | - |
| CHANGE OF MAILING ADDRESS | 2008-03-17 | 2201 NORTH BLVD. WEST, DAVENPORT, FL 33837 | - |
| NAME CHANGE AMENDMENT | 2004-04-05 | KIDSVILLE PEDIATRICS I, P.A. | - |
| CHANGE OF PRINCIPAL ADDRESS | 2002-02-01 | 2201 NORTH BLVD. WEST, DAVENPORT, FL 33837 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-04 |
| ANNUAL REPORT | 2015-02-21 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3495798303 | 2021-01-22 | 0455 | PPS | 2201 North Blvd W, Davenport, FL, 33837-8990 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
