| Entity Name: | MICROSPINE SURGERY CENTER DEFUNIAK SPRINGS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 31 Mar 2003 (22 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L03000011444 |
| FEI/EIN Number | 432006927 |
| Address: | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 32435, US |
| Mail Address: | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 32435, US |
| ZIP code: | 32435 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306891718 | 2006-05-23 | 2007-10-09 | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 324356323, US | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 324356323, US | |||||||||||||||||||||||||
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| Phone | +1 850-892-6001 |
| Fax | 8508924212 |
Authorized person
| Name | ANGEL D BARBER |
| Role | ADMINISTRATOR |
| Phone | 8508926001 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1155 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 6B7 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARBER ANGEL D | Agent | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 32435 |
| Name | Role | Address |
|---|---|---|
| MICROSPINE, INC., A NEVADA CORPORATION | Manager | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL, 32435 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-03-20 | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL 32435 | No data |
| CHANGE OF MAILING ADDRESS | 2007-03-20 | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL 32435 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-03-20 | 101 MICROSPINE WAY, DEFUNIAK SPRINGS, FL 32435 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000377684 | LAPSED | 11CA000341 | WALTON COUNTY CIRCUIT COURT | 2011-04-28 | 2016-06-16 | $90,509.97 | OLYMPUS AMERICA INC., 3500 CORPORATE PARKWAY, CENTER VALLEY PA 18034 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-03-29 |
| ANNUAL REPORT | 2009-01-28 |
| ANNUAL REPORT | 2008-01-09 |
| ANNUAL REPORT | 2007-03-20 |
| ANNUAL REPORT | 2006-01-17 |
| ANNUAL REPORT | 2005-04-19 |
| ANNUAL REPORT | 2004-07-14 |
| Florida Limited Liability | 2003-03-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
