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  5. SOUTHERN ORTHOPEDIC SPECIALISTS, P.A.

SOUTHERN ORTHOPEDIC SPECIALISTS, P.A.

Company Details

Entity Name: SOUTHERN ORTHOPEDIC SPECIALISTS, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Oct 1999 (25 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 29 Nov 2023 (a year ago)
Document Number: P99000090037
FEI/EIN Number 593603332
Mail Address: 1827 HARRISON AVENUE, PANAMA CITY, FL, 32405, US
Address: 1827 HARRISON AVE, PANAMA CITY, FL, 32405
ZIP code: 32405
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1407892938 2006-06-22 2012-03-22 1827 HARRISON AVE, PANAMA CITY, FL, 324057605, US 1827 HARRISON AVE, PANAMA CITY, FL, 324057605, US

Contacts
Phone +1 850-785-4344
Fax 8507856568

Authorized person
Name REBECCA CARREIRA
Role CHIEF FINANCIAL OFFICER
Phone 8507634364

Taxonomy
Taxonomy Code 207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary No
Taxonomy Code 207X00000X - Orthopaedic Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer GROUP BCBS NUMBER
Number 45261
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2023 593603332 2024-10-11 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2024-10-11
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2022 593603332 2023-10-09 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 95
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2021 593603332 2022-07-15 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2022-07-15
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2020 593603332 2021-08-02 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 103
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2021-08-02
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2019 593603332 2020-09-14 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 104
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2020-09-14
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2018 593603332 2019-10-14 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing THOMAS C. MITCHELL
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2017 593603332 2018-07-23 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2018-07-23
Name of individual signing SAMUEL COMBS, MD
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2016 593603332 2017-07-13 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 112
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2017-07-13
Name of individual signing SAMUEL COMBS, MD
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2015 593603332 2016-07-21 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8505224263
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Signature of
Role Plan administrator
Date 2016-07-21
Name of individual signing SAMUEL COMBS, MD
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 401(K) PROFIT SHARING PLAN 2014 593603332 2015-07-24 SOUTHERN ORTHOPEDIC SPECIALISTS, P.A. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 8507856397
Plan sponsor’s address 1827 HARRISON AVE., PANAMA CITY, FL, 32405

Agent

Name Role Address
Cotton John RDr. Agent 1827 HARRISON AVE, PANAMA CITY, FL, 32405

Director

Name Role Address
NOBLE MICHAEL CDr. Director 1827 HARRISON AVE, PANAMA CITY, FL, 32405
Awantang Mark NDr. Director 1827 Harrison Ave, Panama City, FL, 32405
Crossman Nicholas WDr. Director 1827 HARRISON AVENUE, PANAMA CITY, FL, 32405

Vice President

Name Role Address
MITCHELL THOMAS CDr. Vice President 1827 HARRISON AVE, PANAMA CITY, FL, 32405

President

Name Role Address
Cotton John RDr. President 1827 Harrison Ave, Panama City, FL, 32405

Events

Event Type Filed Date Value Description
REINSTATEMENT 2023-11-29 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 No data No data
REGISTERED AGENT NAME CHANGED 2020-07-20 Cotton, John Ryan, Dr. No data
CHANGE OF MAILING ADDRESS 2020-07-20 1827 HARRISON AVE, PANAMA CITY, FL 32405 No data
REINSTATEMENT 2015-11-17 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data
CANCEL ADM DISS/REV 2005-10-07 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2005-09-16 No data No data
CHANGE OF PRINCIPAL ADDRESS 2001-02-01 1827 HARRISON AVE, PANAMA CITY, FL 32405 No data
REGISTERED AGENT ADDRESS CHANGED 2001-02-01 1827 HARRISON AVE, PANAMA CITY, FL 32405 No data

Documents

Name Date
ANNUAL REPORT 2024-02-12
REINSTATEMENT 2023-11-29
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-01-28
ANNUAL REPORT 2020-07-20
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-01-16
ANNUAL REPORT 2016-03-01
REINSTATEMENT 2015-11-17

Related by officers

NOBLE MICHAEL CDr.

BUCKHORN INVESTMENTS, LLC

MITCHELL THOMAS CDr.

BUCKHORN INVESTMENTS, LLC

Awantang Mark NDr.

BUCKHORN INVESTMENTS, LLC

Cotton John RDr.

BUCKHORN INVESTMENTS, LLC

Related by address

1827 HARRISON AVE, PANAMA CITY, FL, 32405

WHITE SANDS MEDICAL LLC COMBS, MITCHELL, SMITH & SHAIEB, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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