| Entity Name: | MICHAEL H. MCCORMICK, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 08 Apr 1992 (33 years ago) |
| Date of dissolution: | 17 Oct 2024 (4 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Oct 2024 (4 months ago) |
| Document Number: | V27965 |
| FEI/EIN Number | 59-3125723 |
| Address: | 1125 BLUESTEM STREET, PANAMA CITY, FL 32405 |
| Mail Address: | 1125 BLUESTEM STREET, PANAMA CITY, FL 32405 |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1811917628 | 2006-07-21 | 2011-12-12 | 2202 STATE AVE, SUITE 300, PANAMA CITY, FL, 324057601, US | 2202 STATE AVE, SUITE 300, PANAMA CITY, FL, 324057601, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-769-2417 |
| Fax | 8507841144 |
Authorized person
| Name | MRS. DORIS B. KELLEY |
| Role | MEDICAL ASSISTANT |
| Phone | 8507692417 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | ME0051595 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | ME104621 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE NPI PURVIS |
| Number | 1407885882 |
| State | FL |
| Issuer | MEDICAID |
| Number | 058854700 |
| State | FL |
| Issuer | MICHAEL L ADAMS MD NPI |
| Number | 1346270881 |
| State | FL |
| Issuer | BLUE SHIELD |
| Number | 14798 |
| State | FL |
| Issuer | MCCORMICK NPI NUMBER |
| Number | 1982677936 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 200012815 |
| State | FL |
| Issuer | MEDICARE |
| Number | 37186Y |
| State | FL |
| Issuer | NPI FOR DEBRA J KELLEY ARNP-C |
| Number | 1477505717 |
| State | FL |
| Issuer | RAILROAD MEDICARE PURVIS |
| Number | P00420317 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL H. MCCORMICK, M.D., P.A. 401K PROFIT SHARING PLAN | 2013 | 593125723 | 2014-04-21 | MICHAEL H. MCCORMICK, M.D., P.A. | 8 | |||||||||||||||||||||||||||||||||||||||||
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| MICHAEL H. MCCORMICK, M.D., P.A. 401K PROFIT SHARING PLAN | 2012 | 593125723 | 2013-07-30 | MICHAEL H. MCCORMICK, M.D., P.A. | 8 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-07-30 |
| Name of individual signing | MICHAEL H MCCORMICK MD |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-07-30 |
| Name of individual signing | MICHAEL H MCCORMICK MD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1992-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8507692417 |
| Plan sponsor’s address | 2202 STATE AVENUE, SUITE 300, PANAMA CITY, FL, 32405 |
Plan administrator’s name and address
| Administrator’s EIN | 593125723 |
| Plan administrator’s name | MICHAEL H. MCCORMICK, M.D., P.A. |
| Plan administrator’s address | 2202 STATE AVENUE, SUITE 300, PANAMA CITY, FL, 32405 |
| Administrator’s telephone number | 8507692417 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-19 |
| Name of individual signing | MICHAEL H MCCORMICK MD |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-07-19 |
| Name of individual signing | MICHAEL H MCCORMICK MD |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| TAYLOR, CHUCK CPA | Agent | 2589 JENKS AVENUE, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| McCormick, Michael H., M.D., P.A. | Director | 1125 BLUESTEM ST., PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| McCormick, Michael H., M.D., P.A. | President | 1125 BLUESTEM ST., PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| McCormick, Martha R | Secretary | 1125 BLUESTEM ST., PANAMA CITY, FL 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-10-17 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-26 | 1125 BLUESTEM STREET, PANAMA CITY, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-26 | 1125 BLUESTEM STREET, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-06 | TAYLOR, CHUCK CPA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-04-19 | 2589 JENKS AVENUE, PANAMA CITY, FL 32405 | No data |
| REINSTATEMENT | 2000-12-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-10-17 |
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-01-13 |
| ANNUAL REPORT | 2016-04-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
