| Entity Name: | PALM BEACH CHILDREN'S ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 13 Sep 1990 (34 years ago) |
| Date of dissolution: | 22 Jan 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Jan 2015 (10 years ago) |
| Document Number: | S02770 |
| FEI/EIN Number | 65-0225549 |
| Address: | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 |
| Mail Address: | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871714394 | 2007-05-01 | 2020-08-22 | 1860 FOREST HILL BLVD, STE 102, WEST PALM BEACH, FL, 334066086, US | 1860 FOREST HILL BLVD, STE 102, WEST PALM BEACH, FL, 334066086, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 561-641-6000 |
| Fax | 5616416006 |
Authorized person
| Name | DR. CONRAD VALENTINO WYNNE JR. |
| Role | PRESIDENT |
| Phone | 5616416000 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME 0055058 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 015509 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 38361 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PALM BEACH CHILDREN'S 401(K) PLAN | 2014 | 650225549 | 2015-02-17 | PALM BEACH CHILDREN'S ASSOCIATES, P.A. | 5 | |||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
| PALM BEACH CHILDREN'S 401(K) PLAN | 2013 | 650225549 | 2014-07-01 | PALM BEACH CHILDREN'S ASSOCIATES, P.A. | 5 | |||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
| PALM BEACH CHILDREN'S 401(K) PLAN | 2012 | 650225549 | 2013-07-29 | PALM BEACH CHILDREN'S ASSOCIATES, P.A. | 7 | |||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2013-07-29 |
| Name of individual signing | CONRAD WYNNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-07-29 |
| Name of individual signing | CONRAD WYNNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WYNNE, CONRAD V., JR., M.D. | Agent | 1860 FOREST HILL BLVD, SUITE 102, WEST PALM BEACH, FL 33406 |
| Name | Role | Address |
|---|---|---|
| WYNNE, CONRAD V., JR. | Director | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 |
| BLAND, REGINA S. | Director | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-01-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-09 | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-09 | 1860 FOREST HILL BLVD STE 102, WEST PALM BEACH, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-01-16 | 1860 FOREST HILL BLVD, SUITE 102, WEST PALM BEACH, FL 33406 | No data |
| NAME CHANGE AMENDMENT | 1990-12-26 | PALM BEACH CHILDREN'S ASSOCIATES, P.A. | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-01-22 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-01-15 |
| ANNUAL REPORT | 2012-02-13 |
| ANNUAL REPORT | 2011-03-24 |
| ANNUAL REPORT | 2010-01-09 |
| ANNUAL REPORT | 2009-02-16 |
| ANNUAL REPORT | 2008-03-04 |
| ANNUAL REPORT | 2007-01-05 |
| ANNUAL REPORT | 2006-02-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
