| Entity Name: | FLORIDA SPINE & PAIN INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Nov 2013 (11 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 06 Sep 2018 (6 years ago) |
| Document Number: | L13000163585 |
| FEI/EIN Number | 46-4311613 |
| Address: | 1804 Oakley Seaver Dr, Clermont, FL, 34711, US |
| Mail Address: | 1804 Oakley SEaver Dr, Clermont, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053769661 | 2016-05-25 | 2023-04-05 | 1804 OAKLEY SEAVER DR STE F, CLERMONT, FL, 347111925, US | 1804 OAKLEY SEAVER DR STE F, CLERMONT, FL, 347111925, US | |||||||||||||||||
|
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| Phone | +1 407-499-0755 |
| Fax | 4075632196 |
| Fax | 4075432564 |
Authorized person
| Name | DARA SANCHEZ |
| Role | MANAGER |
| Phone | 4077444606 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Placer Javier A | Agent | 1804 Oakley Seaver Dr, Clermont, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| PLACER JAVIER A | Managing Member | 1804 Oakley Seaver Dr, Clermont, FL, 34711 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000092996 | SPECIALIZED REHABILITATION PHYSICIAN GROUP | EXPIRED | 2017-08-22 | 2022-12-31 | No data | 835 OAK SHADOWS RD, CELEBRATION, FL, 34747 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-01-27 | 1804 Oakley Seaver Dr, Suite F, Clermont, FL 34711 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-11 | 1804 Oakley Seaver Dr, Suite F, Clermont, FL 34711 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-11 | Placer, Javier A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-11 | 1804 Oakley Seaver Dr, Suite F, Clermont, FL 34711 | No data |
| LC AMENDMENT | 2018-09-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| AMENDED ANNUAL REPORT | 2023-09-28 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-02-11 |
| LC Amendment | 2018-09-06 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
