| Entity Name: | KATHERINE L. BILLINGSLEY, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 03 May 1999 (26 years ago) |
| Date of dissolution: | 21 Jan 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 21 Jan 2015 (10 years ago) |
| Document Number: | P99000041249 |
| FEI/EIN Number | 593577609 |
| Address: | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| Mail Address: | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790868073 | 2006-10-23 | 2012-02-02 | 12276 SAN JOSE BLVD, SUITE 401, JACKSONVILLE, FL, 322238628, US | 12276 SAN JOSE BLVD, SUITE 401, JACKSONVILLE, FL, 322238628, US | |||||||||||||||
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| Phone | +1 904-268-5506 |
| Fax | 9042929170 |
Authorized person
| Name | KATHERINE L BILLINGSLEY |
| Role | OWNERS/MD |
| Phone | 9042685506 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KATHERINE L BILLINGSLEY MD PA 401 K PROFIT SHARING PLAN TRUST | 2013 | 593577609 | 2014-07-17 | KATHERINE L BILLINGSLEY MD PA | 9 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-07-17 |
| Name of individual signing | KATHERINE L. BILLINGSLEY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2008-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9042685506 |
| Plan sponsor’s address | 12276 SAN JOSE BLVD STE 401, JACKSONVILLE, FL, 322238660 |
Signature of
| Role | Plan administrator |
| Date | 2013-06-14 |
| Name of individual signing | KATHERINE L BILLINGSLEY MD PA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2008-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9042685506 |
| Plan sponsor’s address | 12276 SAN JOSE BLVD STE 401, JACKSONVILLE, FL, 322238660 |
Plan administrator’s name and address
| Administrator’s EIN | 593577609 |
| Plan administrator’s name | KATHERINE L BILLINGSLEY MD PA |
| Plan administrator’s address | 12276 SAN JOSE BLVD STE 401, JACKSONVILLE, FL, 322238660 |
| Administrator’s telephone number | 9042685506 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-24 |
| Name of individual signing | KATHERINE L BILLINGSLEY MD PA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BILLINGSLEY KATHERINE L | Agent | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| Name | Role | Address |
|---|---|---|
| BILLINGSLEY KATHERINE L | President | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| Name | Role | Address |
|---|---|---|
| BILLINGSLEY KATHERINE L | Secretary | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| Name | Role | Address |
|---|---|---|
| BILLINGSLEY KATHERINE L | Treasurer | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL, 32223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-01-21 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-04 | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL 32223 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-05-06 | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL 32223 | No data |
| CHANGE OF MAILING ADDRESS | 2004-05-06 | 12276-401 SAN JOSE BLVD, JACKSONVILLE, FL 32223 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-01-21 |
| ANNUAL REPORT | 2014-04-02 |
| ANNUAL REPORT | 2013-04-19 |
| ANNUAL REPORT | 2012-02-29 |
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-04-13 |
| ANNUAL REPORT | 2009-03-27 |
| ANNUAL REPORT | 2008-04-24 |
| ANNUAL REPORT | 2007-04-17 |
| ANNUAL REPORT | 2006-04-19 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
