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  5. TALLAHASSEE NEUROLOGICAL CLINIC, P.A.

TALLAHASSEE NEUROLOGICAL CLINIC, P.A. - Florida Company Profile

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Company Details

Entity Name: TALLAHASSEE NEUROLOGICAL CLINIC, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 16 Mar 1970 (55 years ago)
Document Number: 602005
FEI/EIN Number 591286000
Address: 1401 CENTERVILLE RD,, STE 300, TALLAHASSEE, FL, 32308, US
Mail Address: 1401 CENTERVILLE RD,, STE 300, TALLAHASSEE, FL, 32308
ZIP code: 32308
City: Tallahassee
County: Leon
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MARTIN JAMES T Director 1401 CENTERVILLE RD #300, TALLAHASSEE, FL, 32308
AYALA RICARDO M Director 1401 CENTERVILLE ROAD, #300, TALLAHASSEE, FL, 32308
ORTIZ WINSTON M Director 1401 CENTERVILLE RD #300, TALLAHASSEE, FL, 32308
FUHRMEISTER JOSHUA M Director 1401 CENTERVILLE RD #300, TALLAHASSEE, FL, 32308
Lee Albert SDr. Director 1401 CENTERVILLE RD,, TALLAHASSEE, FL, 32308
Lawson Matthew TDr. Director 1401 CENTERVILLE RD,, TALLAHASSEE, FL, 32308
Lee Albert Dr. Agent 1401 CENTERVILLE RD, TALLAHASSEE, FL, 32308

Unique Entity ID

Unique Entity ID:
DJKVM7S7PMJ3
CAGE Code:
75A60
UEI Expiration Date:
2025-12-05

Business Information

Doing Business As:
TALLAHASSEE NEUROSURGERY PAIN MANAGEMENT, LLC
Activation Date:
2024-12-06
Initial Registration Date:
2020-01-21

Commercial and government entity program

CAGE number:
75A60
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2024-12-06
CAGE Expiration:
2029-12-06
SAM Expiration:
2025-12-05

Contact Information

POC:
JENNIFER BRYAN

National Provider Identifier

NPI Number:
1215103437
Link:
View on NPI website

Authorized Person:

Name:
ANNETTE WILSON
Role:
PA
Phone:
8508788121

Taxonomy:

Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
Yes

Contacts:

Phone:
+1 850-878-8121
Fax:
8509426515

Form 5500 Series

Employer Identification Number (EIN):
591286000
Plan Year:
2023
Number Of Participants:
131
Sponsors Telephone Number:
8508775115
File:
View File
Plan Year:
2021
Number Of Participants:
117
Sponsors Telephone Number:
8505581262
File:
View File
Plan Year:
2017
Number Of Participants:
97
Sponsors Telephone Number:
8508775115
File:
View File
Plan Year:
2016
Number Of Participants:
89
Sponsors Telephone Number:
8508775115
File:
View File
Plan Year:
2015
Number Of Participants:
86
Sponsors Telephone Number:
8508775115
File:
View File

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2018-01-22 Lee, Albert, Dr. -
CHANGE OF PRINCIPAL ADDRESS 2013-09-25 1401 CENTERVILLE RD,, STE 300, TALLAHASSEE, FL 32308 -
CHANGE OF MAILING ADDRESS 2008-01-15 1401 CENTERVILLE RD,, STE 300, TALLAHASSEE, FL 32308 -
REGISTERED AGENT ADDRESS CHANGED 1999-02-24 1401 CENTERVILLE RD, STE 300, TALLAHASSEE, FL 32308 -

Documents

Name Date
ANNUAL REPORT 2025-01-07
ANNUAL REPORT 2024-02-12
ANNUAL REPORT 2023-02-13
ANNUAL REPORT 2022-02-04
ANNUAL REPORT 2021-03-12
ANNUAL REPORT 2020-02-17
ANNUAL REPORT 2019-02-25
ANNUAL REPORT 2018-01-22
ANNUAL REPORT 2017-04-25
ANNUAL REPORT 2016-02-09

USAspending Awards / Contracts

Procurement Instrument Identifier:
15B31420PTB120237
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PURCHASE ORDER
Action Obligation:
55167.00
Base And Exercised Options Value:
55167.00
Base And All Options Value:
55167.00
Awarding Agency Name:
Department of Justice
Performance Start Date:
2018-05-23
Description:
HOSPITAL VISIT FOR PREGNANT INMATE IN MINT PROGRAM
Naics Code:
622310: SPECIALTY (EXCEPT PSYCHIATRIC AND SUBSTANCE ABUSE) HOSPITALS
Product Or Service Code:
Q999: MEDICAL- OTHER
Procurement Instrument Identifier:
DJBP0308NB231569
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PO
Action Obligation:
3196.00
Base And Exercised Options Value:
3196.00
Base And All Options Value:
3196.00
Awarding Agency Name:
Department of Justice
Performance Start Date:
2014-09-02
Description:
IGF::OT::IGF MEDICAL SERVICES - NEUROLOGICAL
Naics Code:
621493: FREESTANDING AMBULATORY SURGICAL AND EMERGENCY CENTERS
Product Or Service Code:
Q510: MEDICAL- NEUROLOGY
Procurement Instrument Identifier:
DJBP0308NB230898
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PO
Action Obligation:
25815.00
Base And Exercised Options Value:
25815.00
Base And All Options Value:
25815.00
Awarding Agency Name:
Department of Justice
Performance Start Date:
2014-04-21
Description:
IGF::OT::IGF MEDICAL SERVICES
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q523: MEDICAL- SURGERY

USAspending Awards / Financial Assistance

Date:
2020-04-08
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
1579100.00
Total Face Value Of Loan:
1579100.00

Paycheck Protection Program

Jobs Reported:
115
Initial Approval Amount:
$1,579,100
Date Approved:
2020-04-08
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$1,579,100
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$1,587,795.87
Servicing Lender:
Prime Meridian Bank
Use of Proceeds:
Payroll: $1,579,100

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Date of last update: 02 Jul 2025

Sources: Florida Department of State

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