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  5. UNIVERSITY PARKWAY MEDICAL CLINIC, INC.

UNIVERSITY PARKWAY MEDICAL CLINIC, INC.

Company Details

Entity Name: UNIVERSITY PARKWAY MEDICAL CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 07 Jun 1991 (34 years ago)
Document Number: S58761
FEI/EIN Number 650271175
Address: 15140 FRUITVILLE RD, SARASOTA, FL, 34240, US
Mail Address: 15140 FRUITVILLE RD, SARASOTA, FL, 34240, US
ZIP code: 34240
County: Sarasota
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1457546897 2007-09-10 2016-02-22 3231 GULF GATE DR, SUITE #101, SARASOTA, FL, 342312406, US 3231 GULF GATE DR, SUITE #101, SARASOTA, FL, 342312406, US

Contacts
Phone +1 941-922-2340
Fax 9419222081

Authorized person
Name DR. SUHAIL A KHOURY
Role PRESIDENT
Phone 9419222340

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME0055732
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS
Number 09766
Issuer RAILROAD MEDICARE
Number 110098404

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2015 650271175 2016-01-21 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 15140 FRUITVILLE ROAD, SARASOTA, FL, 34240
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2014 650271175 2015-07-29 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2013 650271175 2014-06-10 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2014-06-10
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2012 650271175 2013-09-25 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Signature of
Role Plan administrator
Date 2013-09-25
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2011 650271175 2012-05-01 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 650271175
Plan administrator’s name UNIVERSITY PARKWAY MEDICAL CLINIC, INC
Plan administrator’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243
Administrator’s telephone number 9413593337

Signature of
Role Plan administrator
Date 2012-05-01
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2010 650271175 2011-07-06 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 650271175
Plan administrator’s name UNIVERSITY PARKWAY MEDICAL CLINIC, INC
Plan administrator’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243
Administrator’s telephone number 9413593337

Signature of
Role Plan administrator
Date 2011-07-06
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-06
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PARKWAY MEDICAL CLINIC, INC 401(K) 2009 650271175 2010-06-18 UNIVERSITY PARKWAY MEDICAL CLINIC, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 9413593337
Plan sponsor’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243

Plan administrator’s name and address
Administrator’s EIN 650271175
Plan administrator’s name UNIVERSITY PARKWAY MEDICAL CLINIC, INC
Plan administrator’s address 5805 WHITFIELD AVE, SARASOTA, FL, 34243
Administrator’s telephone number 9413593337

Signature of
Role Plan administrator
Date 2010-06-18
Name of individual signing SUHAIL A. KHOURY, PH.D., M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KHOURY, JANET Agent 15140 FRUITVILLE RD, SARASOTA, FL, 34240

President

Name Role Address
KHOURY, SUHAIL M.D. President 15140 FRUITVILLE RD, SARASOTA, FL, 34240

Director

Name Role Address
KHOURY, SUHAIL M.D. Director 15140 FRUITVILLE RD, SARASOTA, FL, 34240

Vice President

Name Role Address
KHOURY SUHAIL Vice President 15140 FRUITVILLE RD, SARASOTA, FL, 34240

Treasurer

Name Role Address
KHOURY SUHAIL Treasurer 15140 FRUITVILLE RD, SARASOTA, FL, 34240

Secretary

Name Role Address
KHOURY SUHAIL Secretary 15140 FRUITVILLE RD, SARASOTA, FL, 34240

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000004012 KHOURY MEDICAL EXPIRED 2016-01-11 2021-12-31 No data 3231 GULF GATE DRIVE, SUITE 101, SARASOTA, FL, 34231
G15000084903 KHOURY MEDICAL INSTITUTE EXPIRED 2015-08-17 2020-12-31 No data 5805 WHITFIELD, SARASOTA, FL, 34243

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data

Related by officers

KHOURY, JANET

SUHAIL A. KHOURY, M.D., P.A. BRADEN RIVER MEDICAL CENTER, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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