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RIVERSIDE SPINE & PAIN PHYSICIANS, LLC

Company Details

Entity Name: RIVERSIDE SPINE & PAIN PHYSICIANS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 25 Feb 2002 (23 years ago)
Document Number: L02000004901
FEI/EIN Number 753046335
Address: 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US
Mail Address: 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982070157 2015-08-11 2015-08-11 7207 GOLDEN WINGS RD, SUITE 100, JACKSONVILLE, FL, 322443324, US 3622 MADACA LN, TAMPA, FL, 336182057, US

Contacts
Phone +1 904-389-1010
Fax 9043891082

Authorized person
Name STEPHEN SCOTT KRAMARICH
Role MEDICAL DIRECTOR
Phone 9043891010

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RIVERSIDE SPINE 401K PLAN 2014 753046335 2015-10-09 RIVERSIDE SPINE & PAIN PHYSICIANS 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD, JACKSONVILLE, FL, 32244

Signature of
Role Plan administrator
Date 2015-10-09
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-09
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE SPINE 401K PLAN 2013 753046335 2014-10-14 RIVERSIDE SPINE & PAIN PHYSICIANS 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD, JACKSONVILLE, FL, 32244

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-14
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE SPINE 401K PLAN 2012 753046335 2013-10-14 RIVERSIDE SPINE & PAIN PHYSICIANS 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD, JACKSONVILLE, FL, 32244

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-14
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE SPINE 401K PLAN 2011 753046335 2012-10-16 RIVERSIDE SPINE & PAIN PHYSICIANS 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD, SUITE 100, JACKSONVILLE, FL, 32244

Plan administrator’s name and address
Administrator’s EIN 753046335
Plan administrator’s name RIVERSIDE SPINE & PAIN PHYSICIANS
Plan administrator’s address 7207 GOLDEN WINGS ROAD, SUITE 100, JACKSONVILLE, FL, 32244
Administrator’s telephone number 9043891010

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-15
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE SPINE 401K PLAN 2010 753046335 2011-10-06 RIVERSIDE SPINE & PAIN PHYSICIANS 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD SUITE 100, JACKSONVILLE, FL, 32244

Plan administrator’s name and address
Administrator’s EIN 753046335
Plan administrator’s name RIVERSIDE SPINE & PAIN PHYSICIANS
Plan administrator’s address 7207 GOLDEN WINGS ROAD SUITE 100, JACKSONVILLE, FL, 32244
Administrator’s telephone number 9043891010

Signature of
Role Plan administrator
Date 2011-10-06
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-06
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE SPINE 401K PLAN 2009 753046335 2010-07-22 RIVERSIDE SPINE & PAIN PHYSICIANS 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621310
Sponsor’s telephone number 9043891010
Plan sponsor’s address 7207 GOLDEN WINGS ROAD SUITE 100, JACKSONVILLE, FL, 32244

Plan administrator’s name and address
Administrator’s EIN 753046335
Plan administrator’s name RIVERSIDE SPINE & PAIN PHYSICIANS
Plan administrator’s address 7207 GOLDEN WINGS ROAD SUITE 100, JACKSONVILLE, FL, 32244
Administrator’s telephone number 9043891010

Signature of
Role Plan administrator
Date 2010-07-22
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-22
Name of individual signing CRAIG KORNICK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

Auth

Name Role Address
BALDOCK JENNIFER Auth 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G13000120021 ALLIANCE PAIN PHYSICIANS EXPIRED 2013-12-09 2018-12-31 No data 7207 GOLDEN WINGS ROAD, SUITE 100, JACKSONVILLE, FL, 32244
G13000046804 RIVERSIDE PAIN PHYSICIANS EXPIRED 2013-05-16 2018-12-31 No data 7207 GOLDEN WINGS ROAD, SUITE 100, JACKSONVILLE, FL, 32244

Events

Event Type Filed Date Value Description
LC AMENDMENT 2017-08-24 No data No data
LC AMENDED AND RESTATED ARTICLES 2016-05-05 No data No data
LC AMENDMENT 2016-04-04 No data No data
LC AMENDED/RESTATED ARTICLE/NAME CHANGE 2015-04-01 RIVERSIDE SPINE & PAIN PHYSICIANS, LLC No data
LC AMENDMENT 2014-01-27 No data No data
AMENDED AND RESTATEDARTICLES 2005-07-11 No data No data

Related by officers

BALDOCK JENNIFER

SARC/LARGO ENDOSCOPY, INC. SARC/JACKSONVILLE, INC. LARGO SURGERY, LLC THE SURGERY CENTER OF OCALA, LLC SARC/LARGO, INC. ANESTHESIOLOGY PROFESSIONAL SERVICES, INC. SGRY SP MANAGEMENT SERVICES, INC. TAMPA PAIN RELIEF CENTER, INC. SARC/FT. MYERS, INC. LAKE MARY SURGERY CENTER, L.L.C.

Related by address

340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US

SARC/JACKSONVILLE, INC. LARGO SURGERY, LLC ASC GAMMA PARTNERS, LTD. THE SURGERY CENTER OF OCALA, LLC SARC/LARGO, INC. ANESTHESIOLOGY PROFESSIONAL SERVICES, INC. SGRY SP MANAGEMENT SERVICES, INC. TAMPA PAIN RELIEF CENTER, INC. SARC/FT. MYERS, INC.

340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US

SARC/JACKSONVILLE, INC. LARGO SURGERY, LLC ASC GAMMA PARTNERS, LTD. THE SURGERY CENTER OF OCALA, LLC SARC/LARGO, INC. ANESTHESIOLOGY PROFESSIONAL SERVICES, INC. SGRY SP MANAGEMENT SERVICES, INC. TAMPA PAIN RELIEF CENTER, INC. SARC/FT. MYERS, INC.

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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