| Entity Name: | HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 29 Sep 1992 (32 years ago) |
| Document Number: | V68075 |
| FEI/EIN Number | 593147948 |
| Address: | 1892 BELLAIR BLVD, ATTN: ED MALLARD III, ORANGE PARK, FL, 32073 |
| Mail Address: | 1892 BELLAIR BLVD, ATTN: ED MALLARD III, ORANGE PARK, FL, 32073 |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568491421 | 2006-07-02 | 2010-01-26 | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 320865164, US | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 320865164, US | |||||||||||||||||||||||
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| Phone | +1 904-825-0046 |
| Fax | 9048261586 |
Authorized person
| Name | MR. ED W MALLARD |
| Role | OWNER |
| Phone | 9048250046 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 340409900 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. 401K PLAN | 2010 | 593147948 | 2011-10-13 | HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. | 20 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 593147948 |
| Plan administrator’s name | HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. |
| Plan administrator’s address | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 320865164 |
| Administrator’s telephone number | 9048250046 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-13 |
| Name of individual signing | EDWARD MALLARD III |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9048250046 |
| Plan sponsor’s address | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 320865164 |
Plan administrator’s name and address
| Administrator’s EIN | 593147948 |
| Plan administrator’s name | HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. |
| Plan administrator’s address | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 320865164 |
| Administrator’s telephone number | 9048250046 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-14 |
| Name of individual signing | EDWARD MALLARD III |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MALLARD III EDWARD W | Agent | 1892 BELLAIR BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| MALLARD III EDWARD W | President | 1892 BELLAIR BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| MALLARD LESLIE P | Vice President | 1892 BELLAIR BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| MALLARD LESLIE P | Treasurer | 1892 BELLAIR BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| MALLARD LESLIE P | Secretary | 1892 BELLAIR BLVD, ORANGE PARK, FL, 32073 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09033900455 | HEALTH PARK MEDICAL | EXPIRED | 2009-02-02 | 2014-12-31 | No data | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 32086 |
| G08207900105 | HEALTH PARK VEIN CENTER | EXPIRED | 2008-07-25 | 2013-12-31 | No data | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 32086 |
| G08207900115 | HEALTH PARK ORTHOTICS, PROSTHETICS AND PEDORTHICS | EXPIRED | 2008-07-25 | 2013-12-31 | No data | 1975 OLD MOULTRIE RD, ST AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REINSTATEMENT | 2010-11-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2005-08-11 | HEALTH PARK FOOT & ANKLE ASSOCIATES, INC. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000173281 | LAPSED | 2010-CA-2645 | CLAY COUNTY CIRCUIT COURT | 2011-03-08 | 2016-03-22 | $42,201.11 | RIKCO INTERNATIONAL, LLC D/B/A DR. COMFORT, C/O WILLIAM M. LINDEMAN, P.A., POST OFFICE BOX 3506, ORLANDO, FL 32802 |
| J10000387339 | LAPSED | 2009-CA-1085 | ST. JOHNS CNTY CLERK OF CRT | 2009-09-22 | 2015-03-08 | $106,497.32 | JOSE M. CONCHA, 5540 SUNSENT LANDING CIRCLE, ST. AUGUSTINE, FL 32080 |
| J10000387313 | LAPSED | 2009-CA-1084 | ST. JOHNS CNTY CLERK OF CRT | 2009-09-22 | 2015-03-08 | $109,129.32 | RICHARD W.S. JOHNSON, 517 BAREFOOT TRACE CIRCLE, ST. AUGUSTINE, FL 32080 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
