| Entity Name: | PAIN CARE MANAGEMENT OF MELBOURNE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Dec 2008 (16 years ago) |
| Document Number: | L08000115271 |
| FEI/EIN Number | 263902823 |
| Mail Address: | 5036 DR PHILLIPS BLVD, 337, ORLANDO, FL, 32819, US |
| Address: | 3210 N WICKHAM RD, Melbourne, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578872602 | 2010-10-07 | 2014-02-13 | 5036 DR PHILLIPS BLVD, SUITE 337, ORLANDO, FL, 328193310, US | 3150 N WICKHAM RD, SUITE 9, MELBOURNE, FL, 329352322, US | |||||||||||||||||||||||
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| Phone | +1 321-251-4462 |
| Fax | 8884691872 |
| Phone | +1 321-773-4134 |
| Fax | 3215745611 |
Authorized person
| Name | MR. C R LONG |
| Role | MANAGING MEMBER |
| Phone | 3212514462 |
Taxonomy
| Taxonomy Code | 261QP3300X - Pain Clinic/Center |
| License Number | PMC1568 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LONG CONNIE R | Agent | 713 DUFF DR, ORLANDO, FL, 34787 |
| Name | Role | Address |
|---|---|---|
| LONG CONNIE R | Managing Member | 5036 DR PHILLIPS BLVD, ORLANDO, FL, 32819 |
| LONG ANNA B | Managing Member | 5036 DR PHILLIPS BLVD, ORLANDO, FL, 32819 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08365900778 | ATLANTIS PAIN CARE | ACTIVE | 2008-12-26 | 2028-12-31 | No data | 5036 DR. PHILLIPS BLVD, SUITE 337, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-23 | 3210 N WICKHAM RD, STE 1, Melbourne, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-18 | 3210 N WICKHAM RD, STE 1, Melbourne, FL 32935 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-18 | 713 DUFF DR, ORLANDO, FL 34787 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-12 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-04-13 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
