| Entity Name: | TAMPA INSTITUTE FOR PAIN AND SPINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
TAMPA INSTITUTE FOR PAIN AND SPINE, 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: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 19 May 2016 (9 years ago) |
| Date of dissolution: | 25 Sep 2020 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (5 years ago) |
| Document Number: | L16000098353 |
| FEI/EIN Number |
81-2746471
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4303 Church Pond Pl, Dover, FL, 33527, US |
| Mail Address: | 3403 Church pond pl, Dover, FL, 33527, US |
| ZIP code: | 33527 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134571128 | 2016-07-01 | 2018-07-31 | 13140 ELK MOUNTAIN DR, SUITE B, RIVERVIEW, FL, 335797182, US | 13140 ELK MOUNTAIN DR, SUITE B, RIVERVIEW, FL, 33579, US | |||||||||||||||||||||||||||||||
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| Phone | +1 813-513-8477 |
Authorized person
| Name | JESSEN MUKALEL |
| Role | PRESIDENT |
| Phone | 8135138477 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 18353700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MUKALEL JESSEN J | Manager | 4303 Church Pond Pl, Dover, FL, 33527 |
| MUKALEL JESSEN J | Agent | 4303 Church pond pl, Dover, FL, 33527 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-12 | 4303 Church Pond Pl, Dover, FL 33527 | - |
| CHANGE OF MAILING ADDRESS | 2019-02-12 | 4303 Church Pond Pl, Dover, FL 33527 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-12 | 4303 Church pond pl, Dover, FL 33527 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-04-08 |
| ANNUAL REPORT | 2017-02-21 |
| Florida Limited Liability | 2016-05-19 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
