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  5. JANET L. BLACK D.P.M., P.A.

JANET L. BLACK D.P.M., P.A.

Company Details

Entity Name: JANET L. BLACK D.P.M., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 21 Dec 1999 (25 years ago)
Date of dissolution: 29 Apr 2024 (9 months ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 29 Apr 2024 (9 months ago)
Document Number: P99000109743
FEI/EIN Number 59-3614117
Address: 3651 LAKE CENTER DR., MT. DORA, FL 32757
Mail Address: 3651 LAKE CENTER DR., MT. DORA, FL 32757
ZIP code: 32757
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891844270 2007-01-09 2015-06-25 3651 LAKE CENTER DR, MOUNT DORA, FL, 327572364, US 3651 LAKE CENTER DR, MOUNT DORA, FL, 327572364, US

Contacts
Phone +1 352-385-9156
Fax 3523859159

Authorized person
Name JANET L BLACK
Role OWNER
Phone 3523859156

Taxonomy
Taxonomy Code 213EP1101X - Primary Podiatric Medicine Podiatrist
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MEDICARE
Number DF7049
State FL
Issuer MEDICARE
Number 1891844270
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JANET L. BLACK, D.P.M., P.A., 401(K) PLAN 2013 593614117 2014-10-10 JANET L. BLACK, D.P.M., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Signature of
Role Plan administrator
Date 2014-10-10
Name of individual signing JANET L. BLACK
Valid signature Filed with authorized/valid electronic signature
JANET L. BLACK, D.P.M., P.A., 401(K) PLAN 2012 593614117 2013-04-23 JANET L. BLACK, D.P.M., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Signature of
Role Plan administrator
Date 2013-04-23
Name of individual signing JANET L. BLACK
Valid signature Filed with authorized/valid electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2011 593614117 2012-05-30 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-05-30
Name of individual signing JANET L. BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2012-05-30
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2011 593614117 2012-06-25 JANET L. BLACK, D.P.M., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-06-25
Name of individual signing JANET L. BLACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-25
Name of individual signing JANET L BLACK
Valid signature Filed with authorized/valid electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-03-16 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-01-18
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-02-16 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-01-18
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-03-21 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-01-18
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-02-22 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-01-18
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-03-21 JANET L. BLACK, D.P.M., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-03-21
Name of individual signing JANET L BLACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-03-21
Name of individual signing JANET L BLACK
Valid signature Filed with authorized/valid electronic signature
JANET L. BLACK, D.P.M., P.A. 401(K) PSP 2010 593614117 2012-02-16 JANET L. BLACK, D.P.M., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 3523859156
Plan sponsor’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593614117
Plan administrator’s name JANET L. BLACK, D.P.M., P.A.
Plan administrator’s address 3651 LAKE CENTER DRIVE, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523859156

Signature of
Role Plan administrator
Date 2012-01-18
Name of individual signing JANET L BLACK
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
BLACK, JANET L Agent 3651 LAKE CENTER DR., MT. DORA, FL 32757

President

Name Role Address
BLACK, JANET L President 3651 Lake Center Dr, Mount Dora, FL 32757

Secretary

Name Role Address
BLACK, JANET L Secretary 3651 Lake Center Dr, Mount Dora, FL 32757

Treasurer

Name Role Address
BLACK, JANET L Treasurer 3651 Lake Center Dr, Mount Dora, FL 32757

Director

Name Role Address
BLACK, JANET L Director 3651 Lake Center Dr, Mount Dora, FL 32757

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G07170900077 MOUNT DORA PODIATRY ACTIVE 2007-06-15 2027-12-31 No data 3651 LAKE CENTER DR., MOUNT DORA, FL, 32757

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2024-04-29 No data No data
REGISTERED AGENT NAME CHANGED 2023-01-21 BLACK, JANET L No data
REGISTERED AGENT ADDRESS CHANGED 2013-04-30 3651 LAKE CENTER DR., MT. DORA, FL 32757 No data
CHANGE OF PRINCIPAL ADDRESS 2007-10-05 3651 LAKE CENTER DR., MT. DORA, FL 32757 No data
CHANGE OF MAILING ADDRESS 2007-10-05 3651 LAKE CENTER DR., MT. DORA, FL 32757 No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2024-04-29
ANNUAL REPORT 2023-01-21
ANNUAL REPORT 2022-04-11
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-01-19
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-04-15
ANNUAL REPORT 2015-04-09

Related by officers

BLACK, JANET L

ROSENJAN FOOD SERVICE EQUIPMENT LLC TOWNS AND CO., LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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