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  5. SOUTH FLORIDA SPINE & SPORTS SPECIALISTS, LLC

SOUTH FLORIDA SPINE & SPORTS SPECIALISTS, LLC

Company Details

Entity Name: SOUTH FLORIDA SPINE & SPORTS SPECIALISTS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 16 Dec 2015 (9 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 13 Oct 2016 (8 years ago)
Document Number: L15000208875
FEI/EIN Number 81-0897649
Address: 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027
Mail Address: 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027
ZIP code: 33027
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1730634643 2016-08-20 2016-08-20 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 330274181, US 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 330274181, US

Contacts
Phone +1 954-551-6921

Authorized person
Name MARK STEVEN FISHMAN
Role MEMBER
Phone 9545516921

Taxonomy
Taxonomy Code 208100000X - Physical Medicine & Rehabilitation Physician
License Number OS9439
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
S. FLORIDA SPINE & SPORTS SPECIALISTS 401(K) 2023 810897649 2024-09-18 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Signature of
Role Plan administrator
Date 2024-09-18
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 401(K) P/S PLAN 2022 810897649 2023-08-31 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Plan administrator’s name and address
Administrator’s EIN 810897649
Plan administrator’s name SOUTH FLORIDA SPINE & SPORTS SPECIALISTS
Plan administrator’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027
Administrator’s telephone number 7875506964

Signature of
Role Plan administrator
Date 2023-08-31
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 401(K) P/S PLAN 2021 810897649 2022-05-31 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Plan administrator’s name and address
Administrator’s EIN 810897649
Plan administrator’s name SOUTH FLORIDA SPINE & SPORTS SPECIALISTS
Plan administrator’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027
Administrator’s telephone number 7875506964

Signature of
Role Plan administrator
Date 2022-05-31
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 401(K) P/S PLAN 2020 810897649 2021-06-03 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Plan administrator’s name and address
Administrator’s EIN 810897649
Plan administrator’s name SOUTH FLORIDA SPINE & SPORTS SPECIALISTS
Plan administrator’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027
Administrator’s telephone number 7875506964

Signature of
Role Plan administrator
Date 2021-06-03
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 401(K) P/S PLAN 2019 810897649 2020-09-28 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Plan administrator’s name and address
Administrator’s EIN 810897649
Plan administrator’s name SOUTH FLORIDA SPINE & SPORTS SPECIALISTS
Plan administrator’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027
Administrator’s telephone number 7875506964

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature
SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 401(K) P/S PLAN 2018 810897649 2019-11-12 SOUTH FLORIDA SPINE & SPORTS SPECIALISTS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 7875506964
Plan sponsor’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027

Plan administrator’s name and address
Administrator’s EIN 810897649
Plan administrator’s name SOUTH FLORIDA SPINE & SPORTS SPECIALISTS
Plan administrator’s address 3000 SW 148TH AVE STE 115, MIRAMAR, FL, 33027
Administrator’s telephone number 7875506964

Signature of
Role Plan administrator
Date 2019-11-12
Name of individual signing FRANCISCO ROMERO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Fishman, Mark Agent 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027

Manager

Name Role Address
ROMERO, FRANCISCO, MD Manager 3000 SW 148 Avenue, Suite 115 Miramar, FL 33027
Fishman, Mark, MD Manager 3000 SW 148 Avenue, Suite 115 Miramar, FL 33027

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2019-04-05 Fishman, Mark No data
REGISTERED AGENT ADDRESS CHANGED 2019-04-05 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027 No data
REINSTATEMENT 2016-10-13 No data No data
CHANGE OF PRINCIPAL ADDRESS 2016-10-13 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027 No data
CHANGE OF MAILING ADDRESS 2016-10-13 3000 SW 148 Avenue, Suite 115, Miramar, FL 33027 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data

Documents

Name Date
ANNUAL REPORT 2025-02-12
ANNUAL REPORT 2024-03-05
ANNUAL REPORT 2023-02-28
ANNUAL REPORT 2022-04-11
ANNUAL REPORT 2021-04-21
ANNUAL REPORT 2020-05-15
ANNUAL REPORT 2019-04-05
ANNUAL REPORT 2018-01-11
ANNUAL REPORT 2017-01-09
REINSTATEMENT 2016-10-13

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4548007205 2020-04-27 0455 PPP 3000 SW 148th Ave 115, Miramar, FL, 33027
Loan Status Date 2021-06-17
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 109391.54
Loan Approval Amount (current) 109391.54
Undisbursed Amount 0
Franchise Name -
Lender Location ID 529050
Servicing Lender Name Square Capital, LLC
Servicing Lender Address 1455 Market Street, Suite 600, San Francisco, CA, 94103
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Miramar, BROWARD, FL, 33027-0800
Project Congressional District FL-25
Number of Employees 10
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 223542
Originating Lender Name Celtic Bank Corporation
Originating Lender Address SALT LAKE CITY, UT
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 110500.44
Forgiveness Paid Date 2021-05-05

Related by officers

Fishman, Mark

735 CONDOMINIUM ASSOCIATION, INC.

Related by address

No related companies by address

Date of last update: 19 Feb 2025

Sources: Florida Department of State

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