| Entity Name: | TRINITY PAIN CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Feb 2010 (15 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 15 Dec 2014 (10 years ago) |
| Document Number: | L10000019111 |
| FEI/EIN Number | 272007397 |
| Address: | 8146 CEREBELLUM WAY, SUITE 102, NEW PORT RICHEY, FL, 34655 |
| Mail Address: | 8146 CEREBELLUM WAY, SUITE 102, NEW PORT RICHEY, FL, 34655 |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942525688 | 2010-04-06 | 2021-11-08 | 8146 CEREBELLUM WAY, SUITE 102, TRINITY, FL, 346551784, US | 8146 CEREBELLUM WAY, SUITE 102, TRINITY, FL, 346551784, US | |||||||||||||||||||||||||||
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| Phone | +1 727-264-8865 |
| Fax | 7276084479 |
| Fax | 8558016125 |
Authorized person
| Name | TERRY M BUSH |
| Role | OFFICE MANAGER |
| Phone | 7272648865 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| License Number | ME98246 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | DD544A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WITTMANN CHRISTOPHER JPA-C | Agent | 2955 LANDING WAY, PALM HARBOR, FL, 34684 |
| Name | Role | Address |
|---|---|---|
| WITTMANN CHRISTOPHER JPA-C | Manager | 8146 CEREBELLUM WAY SUITE 102, NEW PORT RICHEY, FL, 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2014-12-15 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-03-31 | WITTMANN, CHRISTOPHER J, PA-C | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-14 | 8146 CEREBELLUM WAY, SUITE 102, NEW PORT RICHEY, FL 34655 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-14 | 8146 CEREBELLUM WAY, SUITE 102, NEW PORT RICHEY, FL 34655 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-12 |
| ANNUAL REPORT | 2023-05-31 |
| ANNUAL REPORT | 2022-05-15 |
| ANNUAL REPORT | 2021-06-15 |
| ANNUAL REPORT | 2020-07-20 |
| ANNUAL REPORT | 2019-05-16 |
| ANNUAL REPORT | 2018-07-02 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
