| Entity Name: | NASSER MOUKADDEM, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
NASSER MOUKADDEM, M.D., 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: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 28 Jul 1999 (26 years ago) |
| Date of dissolution: | 17 Feb 2024 (a year ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Feb 2024 (a year ago) |
| Document Number: | P99000067159 |
| FEI/EIN Number |
593590539
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL, 33711 |
| Mail Address: | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL, 33711 |
| ZIP code: | 33711 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831220235 | 2007-03-08 | 2013-12-04 | 4226 CENTRAL AVE, ST PETERSBURG, FL, 337111140, US | 4226 CENTRAL AVE, ST PETERSBURG, FL, 337111140, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-321-3915 |
| Fax | 7273280975 |
Authorized person
| Name | NASSER MOUKADDEM |
| Role | PRESIDENT |
| Phone | 7273213915 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME71447 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 260638100 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 110189691 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MY CENTRAL PRIMARY CARE 401(K) PROFIT SHARING PLAN | 2022 | 593590539 | 2023-06-28 | NASSER MOUKADDEM, M.D. P.A. | 8 | |||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2023-06-28 |
| Name of individual signing | DR. NASSER MOUKADDEM |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7273213915 |
| Plan sponsor’s DBA name | MY CENTRAL PRIMARY CARE |
| Plan sponsor’s address | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL, 33711 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-14 |
| Name of individual signing | DR. NASSER MOUKADDEM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7273213915 |
| Plan sponsor’s DBA name | MY CENTRAL PRIMARY CARE |
| Plan sponsor’s address | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL, 33711 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-28 |
| Name of individual signing | DR. NASSER MOUKADDEM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MOUKADDEM NASSER M | Director | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL, 33711 |
| BARKOV MARINA M | Director | 4226 CENTRAL AVE, ST. PETERSBURG, FL, 33711 |
| ARSENAULT KENNETH G | Agent | 10225 ULMERTON ROAD, LARGO, FL, 33771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-02-17 | - | - |
| NAME CHANGE AMENDMENT | 2007-08-21 | NASSER MOUKADDEM, M.D., P.A. | - |
| CHANGE OF PRINCIPAL ADDRESS | 2004-01-25 | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL 33711 | - |
| CHANGE OF MAILING ADDRESS | 2004-01-25 | 4226 CENTRAL AVENUE, ST. PETERSBURG, FL 33711 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2004-01-25 | 10225 ULMERTON ROAD, SUITE 2, LARGO, FL 33771 | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-02-17 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-01-24 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-15 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-12 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4366857103 | 2020-04-13 | 0455 | PPP | 4226 CENTRAL AVE, SAINT PETERSBURG, FL, 33711-1140 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
