| Entity Name: | PREMIER SPINE SPECIALISTS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 22 Jul 2011 (14 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | L11000084945 |
| FEI/EIN Number | 45-2955724 |
| Address: | 10801 SW TRADITION SQUARE, PORT ST. LUCIE, FL 34987 |
| Mail Address: | 10050 SW Innovation Way, Suite 201, PORT ST. LUCIE, FL 34987 |
| ZIP code: | 34987 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669756227 | 2011-09-30 | 2011-09-30 | 10801 SW TRADITION SQ, PORT ST LUCIE, FL, 349871934, US | 10801 SW TRADITION SQ, PORT ST LUCIE, FL, 349871934, US | |||||||||||||||||||
|
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| Phone | +1 772-345-3933 |
| Fax | 7723453937 |
Authorized person
| Name | DR. WILLIAM J JENSEN |
| Role | OWNER |
| Phone | 7723453933 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | ME105483 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Justice, Lynnsey | Agent | 10050 SW Innovation Way, Suite 201, PORT ST. LUCIE, FL 34987 |
| Name | Role | Address |
|---|---|---|
| JENSEN, WILLIAM | Manager | 10050 SW Innovation Way, Suite 201 PORT ST. LUCIE, FL 34987 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2014-02-26 | 10801 SW TRADITION SQUARE, PORT ST. LUCIE, FL 34987 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-02-26 | Justice, Lynnsey | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-26 | 10050 SW Innovation Way, Suite 201, PORT ST. LUCIE, FL 34987 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-02-26 |
| ANNUAL REPORT | 2013-02-18 |
| ANNUAL REPORT | 2012-01-11 |
| Florida Limited Liability | 2011-07-22 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
