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  5. SOUTHWEST FLORIDA SPINE INSTITUTE PLLC

SOUTHWEST FLORIDA SPINE INSTITUTE PLLC

Company Details

Entity Name: SOUTHWEST FLORIDA SPINE INSTITUTE PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 22 Apr 2008 (17 years ago)
Date of dissolution: 10 Oct 2014 (10 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 10 Oct 2014 (10 years ago)
Document Number: L08000040126
FEI/EIN Number 262463854
Address: 3420 TAMIAMI TRAIL, SUITE 1, PORT CHARLOTTE, FL, 33952
Mail Address: P.O. BOX 494409, PORT CHARLOTTE, FL, 33949-4409
ZIP code: 33952
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1700045069 2008-06-03 2008-06-03 PO BOX 494409, PORT CHARLOTTE, FL, 339494409, US 3420 TAMIAMI TRL, SUITE 1, PORT CHARLOTTE, FL, 339528126, US

Contacts
Phone +1 941-979-7310

Authorized person
Name DR. MARIO L PEREIRA
Role PHYSICIAN
Phone 9419797310

Taxonomy
Taxonomy Code 207X00000X - Orthopaedic Surgery Physician
License Number ME98377
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2016 262463854 2017-07-21 SOUTHWEST FLORIDA SPINE INSTITUTE 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9419792585
Plan sponsor’s address 710 BUNKER VIEW, APOLLO BEACH, FL, 33572

Signature of
Role Plan administrator
Date 2017-07-21
Name of individual signing MARIO PEREIRA, M.D.
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2015 262463854 2016-10-15 SOUTHWEST FLORIDA SPINE INSTITUTE 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9419792585
Plan sponsor’s address 1560 KINGSLEY AVENUE, SUITE 3, ORANGE PARK, FL, 32073

Signature of
Role Plan administrator
Date 2016-10-15
Name of individual signing MARIO PEREIRA, M.D.
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2014 262463854 2015-10-15 SOUTHWEST FLORIDA SPINE INSTITUTE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3005 CARING WAY, SUITE 1, PORT CHARLOTTE, FL, 33952

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing MARIO PEREIRA, M.D.
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2013 262463854 2014-10-14 SOUTHWEST FLORIDA SPINE INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3005 CARING WAY, SUITE 1, PORT CHARLOTTE, FL, 33952

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing MARIO PEREIRA, M.D.
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2012 262463854 2013-10-13 SOUTHWEST FLORIDA SPINE INSTITUTE 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3005 CARING WAY, SUITE 1, PORT CHARLOTTE, FL, 33952

Signature of
Role Plan administrator
Date 2013-10-13
Name of individual signing MARIO PEREIRA, M.D.
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2011 262463854 2012-09-20 SOUTHWEST FLORIDA SPINE INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3005 CARING WAY, SUITE 1, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262463854
Plan administrator’s name SOUTHWEST FLORIDA SPINE INSTITUTE
Plan administrator’s address 3005 CARING WAY, SUITE 1, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9412583690

Signature of
Role Plan administrator
Date 2012-09-20
Name of individual signing DIANE PEREIRA
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2010 262463854 2011-05-26 SOUTHWEST FLORIDA SPINE INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3420 TAMIAMI TRAIL, STE 1, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262463854
Plan administrator’s name SOUTHWEST FLORIDA SPINE INSTITUTE
Plan administrator’s address 3420 TAMIAMI TRAIL, STE 1, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9412583690

Signature of
Role Plan administrator
Date 2011-05-26
Name of individual signing DIANE PEREIRA
Valid signature Filed with authorized/valid electronic signature
SOUTHWEST FLORIDA SPINE INSTITUTE 401(K) PLAN 2009 262463854 2010-10-14 SOUTHWEST FLORIDA SPINE INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 9412583690
Plan sponsor’s address 3420 TAMIAMI TRAIL, STE 1, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262463854
Plan administrator’s name SOUTHWEST FLORIDA SPINE INSTITUTE
Plan administrator’s address 3420 TAMIAMI TRAIL, STE 1, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9412583690

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing DIANE PEREIRA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PEREIRA MARIO L Agent 3420 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Managing Member

Name Role Address
PEREIRA MARIO L Managing Member 3420 TAMIAMI TRAIL, SUITE 1, PORT CHARLOTTE, FL, 33952

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2014-10-10 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
CHANGE OF PRINCIPAL ADDRESS 2010-01-15 3420 TAMIAMI TRAIL, SUITE 1, PORT CHARLOTTE, FL 33952 No data
REGISTERED AGENT ADDRESS CHANGED 2010-01-15 3420 TAMIAMI TRAIL, SUITE 1, PORT CHARLOTTE, FL 33952 No data
REGISTERED AGENT NAME CHANGED 2009-03-13 PEREIRA, MARIO L No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2014-10-10
ANNUAL REPORT 2013-04-25
ANNUAL REPORT 2012-03-23
ANNUAL REPORT 2011-04-15
ANNUAL REPORT 2010-01-15
ANNUAL REPORT 2009-03-13
Florida Limited Liability 2008-04-22

Related by officers

No related officers

Related by address

3420 TAMIAMI TRAIL, SUITE 1, PORT CHARLOTTE, FL, 33952

CARDIAC STRESS IMAGING, INC.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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