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CLAY PAIN CENTER PHYSICIANS, LLC - Florida Company Profile

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Company Details

Entity Name: CLAY PAIN CENTER PHYSICIANS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 18 Mar 2009 (16 years ago)
Date of dissolution: 25 Sep 2015 (10 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2015 (10 years ago)
Document Number: L09000026857
FEI/EIN Number 264489679
Address: 1564 KINGSLEY AVE, ORANGE PARK, FL, 32073
Mail Address: 1564 KINGSLEY AVE, ORANGE PARK, FL, 32073
ZIP code: 32073
City: Orange Park
County: Clay
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CLAY SURGERY CENTER, LLP Managing Member 1564 KINGSLEY AVE., ORANGE PARK, FL, 32073
SHAH HEMANT N Managing Member PO BOX 600290, JACKSONVILLE, FL, 32260
BATAINEH MOHAMMAD R Agent 1200 RIVERPLACE BLVD., JACKSONVILLE, FL, 32207

National Provider Identifier

NPI Number:
1659508273

Authorized Person:

Name:
CARL R. NOBACK
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
No
Selected Taxonomy:
208VP0000X - Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09000172539 CLAY PAIN CENTER, LLC EXPIRED 2009-11-05 2014-12-31 - 1564 KINGSLEY AVE, ORANGE PARK, FL, 32073

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 - -
REGISTERED AGENT NAME CHANGED 2012-05-01 BATAINEH, MOHAMMAD R -
REGISTERED AGENT ADDRESS CHANGED 2012-05-01 1200 RIVERPLACE BLVD., STE 705, JACKSONVILLE, FL 32207 -
LC NAME CHANGE 2009-06-29 CLAY PAIN CENTER PHYSICIANS, LLC -

Documents

Name Date
ANNUAL REPORT 2014-04-03
ANNUAL REPORT 2013-04-30
ANNUAL REPORT 2012-05-01
ANNUAL REPORT 2011-03-24
ANNUAL REPORT 2010-04-22
LC Name Change 2009-06-29
Florida Limited Liability 2009-03-18

OSHA's Inspections within Industry

Inspection Summary

Date:
2013-07-11
Type:
Planned
Address:
1564 KINGSLEY AVE., ORANGE PARK, FL, 32073
Safety Health:
Health
Scope:
Complete

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Date of last update: 03 Aug 2025

Sources: Florida Department of State