| Entity Name: | MICROSPINE PHYSICIANS GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Apr 2003 (22 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L03000013667 |
| FEI/EIN Number | 432009997 |
| Address: | 3997 WEST COMMONS DRIVE, SUITE M, DESTIN, FL, 32541, US |
| Mail Address: | 3997 WEST COMMONS DRIVE, SUITE M, DESTIN, FL, 32541, US |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356396774 | 2006-05-24 | 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 | 207RS0010X - Sports Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER (NONPAR) NU |
| Number | 34912 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HAUFE SCOTT | Agent | 302 OLDE POST ROAD, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| HAUFE SCOTT | Manager | 302 OLDE POST ROAD, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-08 | 3997 WEST COMMONS DRIVE, SUITE M, DESTIN, FL 32541 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-08 | 3997 WEST COMMONS DRIVE, SUITE M, DESTIN, FL 32541 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-08 | HAUFE, SCOTT | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-08 | 302 OLDE POST ROAD, NICEVILLE, FL 32578 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-03-14 |
| ANNUAL REPORT | 2011-04-08 |
| 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 | 2004-04-28 |
| Florida Limited Liability | 2003-04-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
