| Entity Name: | SPINE SPECIALISTS OF SOUTH FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Jun 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Apr 2018 (7 years ago) |
| Document Number: | L15000111763 |
| FEI/EIN Number | 47-4497046 |
| Address: | 2047 Palm Beach Lakes Boulevard, West Palm Beach, FL 33409 |
| Mail Address: | 2047 Palm Beach Lakes Boulevard, West Palm Beach, FL 33409 |
| ZIP code: | 33409 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790144004 | 2016-02-15 | 2016-02-15 | 6699 W BOYNTON BEACH BLVD, SUITE B, BOYNTON BEACH, FL, 334373527, US | 6699 W BOYNTON BEACH BLVD, SUITE B, BOYNTON BEACH, FL, 334373527, US | |||||||||||||||||||
|
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| Phone | +1 561-507-0800 |
Authorized person
| Name | CARIANNE YANTZ |
| Role | SURGICAL SCHEDULER |
| Phone | 5615070800 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015608400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Cutler, Jonathan | Agent | 2047 Palm Beach Lakes Boulevard, WEST PALM BEACH, FL 33409 |
| Name | Role | Address |
|---|---|---|
| CUTLER, JONATHAN | Manager | 2047 PALM BEACH LAKES BLVD SUITE 100, WEST PALM BEACH, FL 33409 |
| Name | Role | Address |
|---|---|---|
| WALKER, JACQUELIN | VICE PRESIDENT | 2047 PALM BEACH LAKES BOULEVARD, West Palm Beach, FL 33409 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000013130 | SPINE AND ORTHOPEDIC SPECIALISTS OF SOUTH FLORIDA LLC | ACTIVE | 2020-01-28 | 2025-12-31 | No data | 6699 WEST BOYNTON BEACH BLVD, STE B, BOYNTON BEACH, FL, 33437 |
| G16000032421 | SPINE AND ORTHOPEDIC SPECIALISTS OF CENTRAL FLORIDA | EXPIRED | 2016-03-29 | 2021-12-31 | No data | 6699 BOYNTON BEACH, SUITE B, BOYNTON BEACH, FL, 33437 |
| G15000080236 | SPINE AND ORTHOPEDIC SPECIALISTS OF SOUTH FLORIDA | ACTIVE | 2015-08-03 | 2025-12-31 | No data | 2047 PALM BEACH LAKES BOULEVARD, WEST PALM BEACH, FL, 33409 |
| G15000076575 | ORTHOPEDIC AND SPINE SPECIALISTS OF SOUTH FLORIDA | ACTIVE | 2015-07-23 | 2025-12-31 | No data | 2047 PALM BEACH LAKES BOULEVARD, WEST PALM BEACH, FL, 33409 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2018-04-18 | No data | No data |
| LC AMENDMENT | 2017-08-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-07-21 | 2047 Palm Beach Lakes Boulevard, West Palm Beach, FL 33409 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-07-21 | 2047 Palm Beach Lakes Boulevard, WEST PALM BEACH, FL 33409 | No data |
| CHANGE OF MAILING ADDRESS | 2017-07-21 | 2047 Palm Beach Lakes Boulevard, West Palm Beach, FL 33409 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-07-21 | Cutler, Jonathan | No data |
| LC AMENDMENT | 2015-11-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-01-18 |
| ANNUAL REPORT | 2019-04-03 |
| LC Amendment | 2018-04-18 |
| ANNUAL REPORT | 2018-03-28 |
| LC Amendment | 2017-08-21 |
| AMENDED ANNUAL REPORT | 2017-07-21 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
