| Entity Name: | PENSACOLA SPINE AND SPORTS MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 Apr 2016 (9 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L16000073279 |
| Address: | 6792 LEEPARD RD, MILTON, FL, 32583, US |
| Mail Address: | 6792 LEEPARD RD, MILTON, FL, 32583, US |
| ZIP code: | 32583 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306200860 | 2016-04-11 | 2016-04-11 | 6792 LEEPARD RD, MILTON, FL, 325833343, US | 6792 LEEPARD RD, MILTON, FL, 325833343, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 970-217-1739 |
Authorized person
| Name | DR. ERIC SHOEMAKER |
| Role | PHYSICIAN |
| Phone | 9702171739 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | OS13075 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 14406200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHOEMAKER ERIC M | Agent | 6792 LEEPARD RD, MILTON, FL, 32583 |
| Name | Role | Address |
|---|---|---|
| SHOEMAKER JENNIFER A | Manager | 6792 LEEPARD RD, MILTON, FL, 32583 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2016-04-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
