| Entity Name: | MARTIN COUNTY PAIN CLINIC, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Mar 2005 (20 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 31 Jul 2012 (13 years ago) |
| Document Number: | L05000030377 |
| FEI/EIN Number | 202589755 |
| Address: | 725 SE OSCEOLA STREET, STUART, FL, 34994-2318, US |
| Mail Address: | 725 SE OSCEOLA STREET, SUITE 2, STUART, FL, 34994-2318, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942252531 | 2006-05-16 | 2019-05-06 | 725 SE OSCEOLA ST STE 2, STUART, FL, 349942318, US | 725 SE OSCEOLA ST, SUITE 2, STUART, FL, 349942318, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-286-0078 |
| Fax | 7722862288 |
| Fax | 8666652702 |
Authorized person
| Name | ALBERT E GARDNER |
| Role | PRESIDENT |
| Phone | 7722860078 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | ME15899 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 274837100 |
| State | FL |
| Issuer | BCBS FL GROUP # |
| Number | 39289 |
| State | FL |
| Name | Role |
|---|---|
| FOX MCCLUSKEY BUSH ROBISON, PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| GARDNER ALBERT E | President | 725 E OSCEOLA STREET, STUART, FL, 349942318 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-08-23 | 725 SE OSCEOLA STREET, SUITE 2, STUART, FL 34994-2318 | No data |
| CHANGE OF MAILING ADDRESS | 2023-08-23 | 725 SE OSCEOLA STREET, SUITE 2, STUART, FL 34994-2318 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-02-15 | Fox McCluskey Bush Robison, PLLC | No data |
| LC AMENDMENT | 2012-07-31 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-12-01 | 3473 SE WILLOUGHBY BLVD, STUART, FL 34994 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| AMENDED ANNUAL REPORT | 2023-08-23 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-26 |
| AMENDED ANNUAL REPORT | 2021-02-15 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-01-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
