| Entity Name: | SUNSHINE PAIN MANAGEMENT MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 May 2010 (15 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Oct 2018 (6 years ago) |
| Document Number: | L10000048744 |
| FEI/EIN Number | 800592095 |
| Mail Address: | 15292 SW 17TH ST, DAVIE, FL, 33326, US |
| Address: | 915 NE 125 STREET, SUITE 301, NORTH MIAMI, FL, 33161, US |
| ZIP code: | 33161 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124310651 | 2011-05-03 | 2019-01-09 | 915 NE 125TH ST STE 301, NORTH MIAMI, FL, 331615746, US | 915 NE 125TH ST STE 301, NORTH MIAMI, FL, 331615746, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 305-836-1421 |
| Fax | 3058361442 |
Authorized person
| Name | DR. MOGIN ANTOINE |
| Role | PRESIDENT |
| Phone | 3058361421 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | FP528A |
| Issuer | MEDICAID |
| Number | 004239400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ANTOINE MOGIN M | Agent | 15292 SW 17TH ST, DAVIE, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| ANTOINE MOGIN M | Manager | 15292 SW 17TH ST, DAVIE, FL, 33326 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000038777 | ALLIANCE PAIN MANAGEMENT, LLC | EXPIRED | 2013-04-22 | 2018-12-31 | No data | 1190 NW 95TH STREET, SUITE 303, MIAMI, FL, 33150 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-25 | 915 NE 125 STREET, SUITE 301, NORTH MIAMI, FL 33161 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-25 | 15292 SW 17TH ST, DAVIE, FL 33326 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-30 | 915 NE 125 STREET, SUITE 301, NORTH MIAMI, FL 33161 | No data |
| REINSTATEMENT | 2018-10-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-25 | ANTOINE, MOGIN MD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2010-05-24 | SUNSHINE PAIN MANAGEMENT MEDICAL CENTER, LLC | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001475897 | TERMINATED | 1000000532911 | HIGHLANDS | 2013-09-13 | 2033-10-03 | $ 300.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-03-25 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-30 |
| REINSTATEMENT | 2018-10-25 |
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
