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  5. PSYCHIATRIC ASSOCIATES, P.A.

PSYCHIATRIC ASSOCIATES, P.A.

Company Details

Entity Name: PSYCHIATRIC ASSOCIATES, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 06 Apr 1999 (26 years ago)
Date of dissolution: 28 Sep 2018 (6 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2018 (6 years ago)
Document Number: P99000031368
FEI/EIN Number 593569719
Address: 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL, 32073
Mail Address: 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL, 32073
ZIP code: 32073
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255740767 2014-08-08 2014-08-08 1543 KINGSLEY AVE STE 14, ORANGE PARK, FL, 320734570, US 1543 KINGSLEY AVE STE 14, ORANGE PARK, FL, 320734570, US

Contacts
Phone +1 904-264-6977
Fax 9042690870

Authorized person
Name LANAH W LARSON
Role SECRETARY, PRACTICE ADMINISTRATOR
Phone 9042646977

Taxonomy
Taxonomy Code 2084P0800X - Psychiatry Physician
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 25939900
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2023 591364817 2024-07-25 PSYCHIATRIC ASSOCIATES, P.A. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2024-07-25
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2022 591364817 2023-09-07 PSYCHIATRIC ASSOCIATES, P.A. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2023-09-07
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2021 591364817 2022-06-23 PSYCHIATRIC ASSOCIATES, P.A. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2022-06-23
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2020 591364817 2021-05-27 PSYCHIATRIC ASSOCIATES, P.A. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2021-05-27
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2019 591364817 2021-07-15 PSYCHIATRIC ASSOCIATES, P.A. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2019 591364817 2021-01-14 PSYCHIATRIC ASSOCIATES, P.A. 14
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2021-01-14
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2018 591364817 2019-09-26 PSYCHIATRIC ASSOCIATES, P.A. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SHADOW LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2019-09-26
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2017 591364817 2018-10-04 PSYCHIATRIC ASSOCIATES, P.A. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 814 SADDLE LANE, SUITE B, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2018-10-04
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2016 591364817 2017-09-28 PSYCHIATRIC ASSOCIATES, P.A. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 235 CARMEL DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2017-09-28
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature
PSYCHIATRIC ASSOCIATES, P.A. EMPLOYEES' PROFIT SHARING PLAN 2015 591364817 2016-09-08 PSYCHIATRIC ASSOCIATES, P.A. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-08-01
Business code 621111
Sponsor’s telephone number 8508623141
Plan sponsor’s address 235 CARMEL DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2016-09-08
Name of individual signing GEORGE A. MICHAS, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NULAND CHRISTOPHER L Agent 1000 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204

PDM

Name Role Address
LARSON JAMES LMD PDM 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL, 32073

Secretary

Name Role Address
LARSON LANAH W Secretary 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL, 32073

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data
AMENDED AND RESTATEDARTICLES/NAME CHANGE 2002-03-05 PSYCHIATRIC ASSOCIATES, P.A. No data
REGISTERED AGENT ADDRESS CHANGED 2002-03-05 1000 RIVERSIDE AVENUE, SUITE 115, JACKSONVILLE, FL 32204 No data
CHANGE OF PRINCIPAL ADDRESS 2000-03-06 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL 32073 No data
CHANGE OF MAILING ADDRESS 2000-03-06 1543 KINGSLEY AVENUE, BUILDING 14, ORANGE PARK, FL 32073 No data

Documents

Name Date
ANNUAL REPORT 2017-03-28
ANNUAL REPORT 2016-03-10
ANNUAL REPORT 2015-01-28
ANNUAL REPORT 2014-03-03
ANNUAL REPORT 2013-01-28
ANNUAL REPORT 2012-03-22
ANNUAL REPORT 2011-04-25
ANNUAL REPORT 2010-03-01
ANNUAL REPORT 2009-04-23
ANNUAL REPORT 2008-02-01

Related by officers

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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