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  5. PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC

PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC

Company Details

Entity Name: PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Mar 2006 (19 years ago)
Last Event: LC AMENDED AND RESTATED ARTICLES
Event Date Filed: 17 Jul 2006 (19 years ago)
Document Number: L06000030721
FEI/EIN Number 593467482
Mail Address: 110 CAMPBELL DRIVE, WINTER HAVEN, FL, 33884
Address: 537 E. CENTRAL AVENUE, SUITE B, WINTER HAVEN, FL, 33880
ZIP code: 33880
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1700988672 2006-09-02 2010-04-22 321 E ROBERTSON ST, BRANDON, FL, 335115253, US 537 E CENTRAL AVE, WINTER HAVEN, FL, 338803054, US

Contacts
Phone +1 813-685-2191
Fax 8136898755
Phone +1 863-293-3656
Fax 8632937887

Authorized person
Name PEGGY E VENT
Role BILLING REP
Phone 8136852191

Taxonomy
Taxonomy Code 208VP0000X - Pain Medicine Physician
State FL
Is Primary Yes

Other Provider Identifiers
Issuer TAX ID
Number 593467412
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2023 593467482 2024-02-02 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8632933656
Plan sponsor’s address 110 CAMPBELL DRIVE, WINTER HAVEN, FL, 33884
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2022 593467482 2023-06-06 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8632933656
Plan sponsor’s address 537 EAST CENTRAL AVENUE SUITE B, WINTER HAVEN, FL, 33880
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2021 593467482 2022-10-20 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8632933656
Plan sponsor’s address 537 EAST CENTRAL AVENUE SUITE B, WINTER HAVEN, FL, 33880
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2020 593467482 2021-06-28 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8632933656
Plan sponsor’s address 537 EAST CENTRAL AVENUE SUITE B, WINTER HAVEN, FL, 33880
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2019 593467482 2020-07-27 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8632933656
Plan sponsor’s address 537 EAST CENTRAL AVENUE SUITE B, WINTER HAVEN, FL, 33880
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2018 593467482 2019-03-14 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2017 593467482 2018-05-29 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2016 593467482 2017-08-23 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2017-08-23
Name of individual signing CAROLINE HONCULADA
Valid signature Filed with authorized/valid electronic signature
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2015 593467482 2016-10-11 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing CAROLINE HONCULADA
Valid signature Filed with authorized/valid electronic signature
PAIN DIAGNOSTIC & MANAGEMENT CENTER, P.A. PROFIT SHARING PLAN 2014 593467482 2015-10-05 PAIN DIAGNOSTIC & MANAGEMENT CENTER, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 8636799494
Plan sponsor’s address 425 SOUTH 11TH STREET, SUITE 1, LAKE WALES, FL, 33853

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing CAROLINE HONCULADA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HONCULADA CAROLINE C Agent 110 CAMPBELL DRIVE, WINTER HAVEN, FL, 33884

Manager

Name Role Address
HONCULADA ALLAN C Manager 537 E. CENTRAL AVENUE, SUITE B, WINTER HAVEN, FL, 33880

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2009-01-15 537 E. CENTRAL AVENUE, SUITE B, WINTER HAVEN, FL 33880 No data
REGISTERED AGENT NAME CHANGED 2009-01-15 HONCULADA, CAROLINE C No data
REGISTERED AGENT ADDRESS CHANGED 2009-01-15 110 CAMPBELL DRIVE, WINTER HAVEN, FL 33884 No data
LC AMENDED AND RESTATED ARTICLES 2006-07-17 No data No data
CONVERSION 2006-03-23 No data CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P97000079028. CONVERSION NUMBER 500000056175

Documents

Name Date
ANNUAL REPORT 2024-03-14
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-01-21
ANNUAL REPORT 2021-01-28
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-01-25
ANNUAL REPORT 2015-01-29

Related by officers

HONCULADA ALLAN C

PAIN DIAGNOSTIC & MANAGEMENT CENTER, P,A.

HONCULADA CAROLINE C

PHYSICIAN BILLING AND ADVANCED SOLUTIONS LLC MASTERPIECE, LLC CAROLINE C. HONCULADA M.D., P.A. EAGLE POND, LLC CEBU INVESTMENTS, LLC ENCLAVE CYPRESSWOOD, LLC EAST CENTRAL AVENUE, LLC LAKE WALES LINDEN LANE, LLC CAROLINE C. HONCULADA M.D., LLC

Related by address

110 CAMPBELL DRIVE, WINTER HAVEN, FL, 33884

MASTERPIECE, LLC EAGLE POND, LLC ENCLAVE CYPRESSWOOD, LLC EAST CENTRAL AVENUE, LLC LAKE WALES LINDEN LANE, LLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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