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  5. CAMERON SPINE LLC

CAMERON SPINE LLC

Company Details

Entity Name: CAMERON SPINE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 07 Sep 2010 (14 years ago)
Document Number: L10000093534
FEI/EIN Number 273399686
Address: 6080 Boynton Beach Blvd, Suite # 100, Boynton Beach, FL, 33437, US
Mail Address: 6586 HYPOLUXO ROAD STE 334, LAKE WORTH, FL, 33467, US
ZIP code: 33437
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1396054938 2010-09-30 2018-08-16 6586 HYPOLUXO RD, STE 334, LAKE WORTH, FL, 33467, US 12989 SOUTHERN BLVD, SUITE 202, LOXAHATCHEE, FL, 33470, US

Contacts
Phone +1 877-412-7272
Fax 5619670954

Authorized person
Name DR. BLAINE SIMONE CAMERON
Role OWNER/PRINCIPAL
Phone 9545302643

Taxonomy
Taxonomy Code 208VP0014X - Interventional Pain Medicine Physician
License Number ME86864
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CAMERON SPINE 401K PLAN 2023 273399686 2024-05-28 CAMERON SPINE, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2024-05-28
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2022 273399686 2023-06-01 CAMERON SPINE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2023-06-01
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2021 273399686 2022-06-24 CAMERON SPINE, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2022-06-24
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2020 273399686 2021-07-15 CAMERON SPINE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2019 273399686 2020-06-30 CAMERON SPINE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2019 273399686 2020-06-19 CAMERON SPINE, LLC 4
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2020-06-19
Name of individual signing MCAMERON9402
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2018 273399686 2019-07-11 CAMERON SPINE, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2019-07-11
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2017 273399686 2018-07-12 CAMERON SPINE, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2018-07-12
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature
CAMERON SPINE 401K PLAN 2016 273399686 2017-09-19 CAMERON SPINE, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-03-01
Business code 621111
Sponsor’s telephone number 9548685201
Plan sponsor’s address 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Signature of
Role Plan administrator
Date 2017-09-19
Name of individual signing MARSHA CAMERON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CAMERON BLAINE Agent 6586 HYPOLUXO ROAD STE 334, LAKE WORTH, FL, 33467

Managing Member

Name Role Address
CAMERON BLAINE Managing Member 11860 NW 17TH PLACE, PLANTATION, FL, 33323

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-06-21 6080 Boynton Beach Blvd, Suite # 100, Boynton Beach, FL 33437 No data
REGISTERED AGENT ADDRESS CHANGED 2024-06-21 6586 HYPOLUXO ROAD STE 334, LAKE WORTH, FL 33467 No data
CHANGE OF PRINCIPAL ADDRESS 2019-02-04 6080 Boynton Beach Blvd, Suite # 100, Boynton Beach, FL 33437 No data

Documents

Name Date
AMENDED ANNUAL REPORT 2024-06-21
ANNUAL REPORT 2024-02-01
ANNUAL REPORT 2023-03-01
ANNUAL REPORT 2022-02-18
ANNUAL REPORT 2021-04-13
ANNUAL REPORT 2020-02-10
ANNUAL REPORT 2019-02-04
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-01-12
ANNUAL REPORT 2016-02-01

Related by officers

CAMERON BLAINE

DURABLE MEDICAL EQUIPMENT EXPORTING, LLC LIGHTHOUSE PAIN & ANESTHESIA LLC 36D, LLC CAMERON SCHOLARSHIP CENTER, INC. CAMERON HOLDINGS, INC. CAMERON CLINICS LLC BCMD PAIN MANAGEMENT, LLC SAFESURGERY INC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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