| Entity Name: | INSTITUTE FOR COLLEGIATE SPORTS MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 28 Mar 2012 (13 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L12000044387 |
| FEI/EIN Number | 45-5441679 |
| Address: | 2551 N Rock Island Rd, 306, Margate, FL 33063 |
| Mail Address: | 2551 N Rock Island Rd, 306, Margate, FL 33063 |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730426305 | 2013-01-15 | 2013-01-15 | PO BOX 669582, POMPANO BEACH, FL, 330669582, US | 3511 SAHARA SPRINGS BLVD, POMPANO BEACH, FL, 330696101, US | |||||||||||||
|
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| Phone | +1 954-204-5428 |
Authorized person
| Name | BRIAN ANDERSON |
| Role | PRESIDENT |
| Phone | 9542045428 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ANDERSON, BRIAN | Agent | 2551 North Rock Island Rd, 306, Margate, FL 33063 |
| Name | Role | Address |
|---|---|---|
| ANDERSON, BRIAN | Managing Member | 2551 N Rock Island Rd, 306 Margate, FL 33063 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-26 | 2551 North Rock Island Rd, 306, Margate, FL 33063 | No data |
| REINSTATEMENT | 2018-02-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-26 | 2551 N Rock Island Rd, 306, Margate, FL 33063 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-26 | 2551 N Rock Island Rd, 306, Margate, FL 33063 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-01-05 | ANDERSON, BRIAN | No data |
| REINSTATEMENT | 2015-01-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| LC AMENDMENT | 2012-06-22 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2018-02-26 |
| REINSTATEMENT | 2015-01-05 |
| LC Amendment | 2012-06-22 |
| Florida Limited Liability | 2012-03-28 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
