| Entity Name: | PAIN MANAGEMENT PHYSICIANS OF SOUTH FLORIDA, P.L. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Jun 2006 (19 years ago) |
| Document Number: | L06000058825 |
| FEI/EIN Number | 205015243 |
| Address: | 8880 ROYAL PALM BLVD, CORAL SPRINGS, FL, 33065, US |
| Mail Address: | 8880 ROYAL PALM BLVD, CORAL SPRINGS, FL, 33065, US |
| ZIP code: | 33065 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922037290 | 2006-06-30 | 2013-09-10 | 6295 NW 96TH TER, PARKLAND, FL, 330761815, US | 8880 ROYAL PALM BLVD, SUITE 103, CORAL SPRINGS, FL, 330655727, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-605-3724 |
| Fax | 9542559147 |
| Phone | +1 954-975-8233 |
| Fax | 9549742335 |
Authorized person
| Name | ANDREW JAY GOLDBERG |
| Role | PRESIDENT |
| Phone | 9546053724 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME 66192 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER LICENSE NUMBER |
| Number | ME 66192 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Lee Tse CDr. | Agent | 8880 Royal Palm Blvd, Coral Springs, FL, 33065 |
| Name | Role |
|---|---|
| DR. TSE CHUNG LEE, PL LLC | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-24 | 8880 ROYAL PALM BLVD, SUITE 103, CORAL SPRINGS, FL 33065 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-24 | 8880 ROYAL PALM BLVD, SUITE 103, CORAL SPRINGS, FL 33065 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-19 | Lee, Tse Chung, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-19 | 8880 Royal Palm Blvd, Suite 103, Coral Springs, FL 33065 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| AMENDED ANNUAL REPORT | 2023-10-13 |
| ANNUAL REPORT | 2023-03-18 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-06 |
| ANNUAL REPORT | 2020-02-23 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
