| Entity Name: | THE INSTITUTE FOR HEALTH, SPORTS, SPINE REHABILITATION & PAIN MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
THE INSTITUTE FOR HEALTH, SPORTS, SPINE REHABILITATION & PAIN MANAGEMENT, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 01 Sep 2015 (10 years ago) |
| Document Number: | L15000147053 |
| FEI/EIN Number |
47-4966216
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1895 KINGSLEY AVE, ORANGE PARK, FL, 32073, US |
| Mail Address: | 1895 KINGSLEY AVE, ORANGE PARK, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245802727 | 2021-07-14 | 2021-07-14 | 111 MARGARET ST, SAINT MARYS, GA, 315584930, US | 4100 SOUTHPOINT DR E STE 1, JACKSONVILLE, FL, 322168710, US | |||||||||||||||||||||
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| Phone | +1 904-647-5266 |
| Fax | 9047705594 |
Authorized person
| Name | SHANNON RILEY |
| Role | VP OF OPERATIONS |
| Phone | 9046475266 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014945000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| von Tobel Travis | Member | 1895 Kingsley Ave, Orange Park, FL, 32073 |
| RILEY SHANNON | Agent | 1895 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000093392 | THE INSTITUTE FOR FLORIDA PAIN SPECIALISTS | ACTIVE | 2021-07-16 | 2026-12-31 | - | 1604 MARARET STREET, JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-02-10 | von Tobel, Travis | - |
| REGISTERED AGENT ADDRESS CHANGED | 2025-02-10 | 3941 W Alhambra Dr, Jacksonville, FL 32207 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-12 | 1895 KINGSLEY AVE, 1005B, ORANGE PARK, FL 32073 | - |
| CHANGE OF MAILING ADDRESS | 2024-02-12 | 1895 KINGSLEY AVE, 1005B, ORANGE PARK, FL 32073 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-12 | 1895 KINGSLEY AVE, 1005B, ORANGE PARK, FL 32073 | - |
| REGISTERED AGENT NAME CHANGED | 2019-02-22 | RILEY, SHANNON | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000723262 | TERMINATED | 1000000800130 | CLAY | 2018-10-18 | 2028-10-31 | $ 142.78 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825 |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2025-02-10 |
| ANNUAL REPORT | 2025-02-08 |
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-03-16 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-02-22 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-05-01 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
