| Entity Name: | FLORIDA MEDICAL PAIN MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Sep 2007 (17 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Nov 2015 (9 years ago) |
| Document Number: | L07000092536 |
| FEI/EIN Number | 260874803 |
| Address: | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL, 33709, US |
| Mail Address: | PO BOX 48639, ST. PETERSBURG, FL, 33743, US |
| ZIP code: | 33709 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831614080 | 2017-08-09 | 2017-08-09 | P.O. BOX 48639, ST. PETERSBURG, FL, 33743, US | 5270 APPLEGATE DRIVE, SPRING HILL, FL, 34606, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 727-548-6100 |
| Fax | 7275450960 |
| Phone | +1 352-340-5990 |
| Fax | 3523405990 |
Authorized person
| Name | MR. KAZI M. HASSAN |
| Role | MEDICAL DIRECTOR |
| Phone | 7275486100 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | ME66904 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012510800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Hassan Sana | Agent | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL, 33709 |
| Name | Role | Address |
|---|---|---|
| HASSAN KAZI M | Manager | 6333 54TH AVE.N., ST. PETERSBURG, FL, 33709 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000067836 | AURA WELLNESS & AESTHETICS | ACTIVE | 2024-05-29 | 2029-12-31 | No data | PO BOX 48639, ST. PETERSBURG, FL, 33743 |
| G24000066367 | AURA AESTHETICS & WELLNESS | ACTIVE | 2024-05-23 | 2029-12-31 | No data | PO BOX 48639, ST. PETERSBURG, FL, 33743 |
| G14000076778 | FMPM RESEARCH | EXPIRED | 2014-07-24 | 2019-12-31 | No data | 6333 54TH AVE N, ST PETERSBURG, FL, 33709 |
| G11000098743 | TAMPA INTERVENTIONAL SPINE PHYSICIANS | EXPIRED | 2011-10-06 | 2016-12-31 | No data | 6333 54TH AVE N, ST PETERSBURG, FL, 33709 |
| G10000115282 | FLORIDA MEDICAL PAIN MANAGEMENT NEW PORT RICHEY | EXPIRED | 2010-12-16 | 2015-12-31 | No data | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL, 33709 |
| G10000039213 | FLORIDA MEDICAL PAIN MANAGEMENT SPRING HILL | EXPIRED | 2010-05-04 | 2015-12-31 | No data | 6333 54TH AVENUE N, ST. PETERSBURG, FL, 33709 |
| G10000036627 | FLORIDA MEDICAL PAIN MANAGEMENT SPRING HILL OFFICE | EXPIRED | 2010-04-26 | 2015-12-31 | No data | 6333 54TH AVENUE N, ST. PETERSBURG, FL, 33709 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-10 | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL 33709 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-10 | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL 33709 | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-22 | 6333 54TH AVENUE NORTH, ST. PETERSBURG, FL 33709 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-17 | Hassan, Sana | No data |
| REINSTATEMENT | 2015-11-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| LC NAME CHANGE | 2008-11-18 | FLORIDA MEDICAL PAIN MANAGEMENT, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-03-22 |
| ANNUAL REPORT | 2016-03-17 |
| REINSTATEMENT | 2015-11-09 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
