| Entity Name: | PAIN MEDICINE PHYSICIANS OF JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Nov 2010 (14 years ago) |
| Document Number: | L10000120859 |
| FEI/EIN Number | 274098224 |
| Address: | 10250 NORMANDY BLVD., JACKSONVILLE, FL, 32221, US |
| Mail Address: | 10250 Normandy Blvd., STE 702, JACKSONVILLE, FL, 32221, US |
| ZIP code: | 32221 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942603899 | 2014-10-07 | 2017-01-27 | 10250 NORMANDY BLVD, SUITE 703, JACKSONVILLE, FL, 322218059, US | 10250 NORMANDY BOULEVARD, SUITE 702, JACKSONVILLE, FL, 32221, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-495-7200 |
| Fax | 9044957199 |
Authorized person
| Name | DR. PARVEEN KHANNA |
| Role | MEDICAL DIRECTOR |
| Phone | 9044957200 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | ME87424 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME87424 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECROSSBLUESHIELD |
| Number | 007Z4 |
| State | FL |
| Issuer | MEDICARE RR |
| Number | DV2304 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHANNA SANJEEV | Agent | 10250 Normandy Blvd, JACKSONVILLE, FL, 32221 |
| Name | Role | Address |
|---|---|---|
| KHANNA PARVEEN Dr. | President | 10250 Normandy Blvd., JACKSONVILLE, FL, 32221 |
| Name | Role | Address |
|---|---|---|
| KHANNA SANJEEV | Vice President | 10250 Normandy Blvd., JACKSONVILLE, FL, 32221 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000026892 | SPARK REGENERATIVE MEDICINE | EXPIRED | 2018-02-23 | 2023-12-31 | No data | 10250 NORMANDY BLVD., SUITE 703, JACKSONVILLE, FL, 32221 |
| G16000138431 | JAX INNOVATIVE MEDICINE | EXPIRED | 2016-12-23 | 2021-12-31 | No data | 10250 NORMANDY BLVD., STE 702, JACKSONVILLE, FL, 32221 |
| G16000133657 | JACKSONVILLE CENTER FOR INNOVATIVE MEDICINE | EXPIRED | 2016-12-12 | 2021-12-31 | No data | 10250 NORMANDY BLVD., STE. 703, JACKONSVILLE, FL, 32221 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-19 | 10250 Normandy Blvd, Suite 702, JACKSONVILLE, FL 32221 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-16 | 10250 NORMANDY BLVD., SUITE 703, JACKSONVILLE, FL 32221 | No data |
| CHANGE OF MAILING ADDRESS | 2014-02-25 | 10250 NORMANDY BLVD., SUITE 703, JACKSONVILLE, FL 32221 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-09 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-18 |
| ANNUAL REPORT | 2016-02-19 |
| ANNUAL REPORT | 2015-01-16 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
