| Entity Name: | COLLIER ANESTHESIA PAIN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Sep 2016 (8 years ago) |
| Date of dissolution: | 28 Mar 2024 (10 months ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Mar 2024 (10 months ago) |
| Document Number: | L16000169546 |
| FEI/EIN Number | 20-1224861 |
| Address: | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN 37027 |
| Mail Address: | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN 37027 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306899349 | 2006-05-19 | 2022-07-21 | PO BOX 638900, CINCINNATI, OH, 452638900, US | 4035 EVANS AVE, SUITE 1, FORT MYERS, FL, 339019308, US | |||||||||||||||||||||||
|
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| Phone | +1 239-939-7375 |
| Fax | 2399395105 |
Authorized person
| Name | WAYNE ISAACSON |
| Role | MD |
| Phone | 2399397375 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 94852 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BALDOCK, JENNIFER | MANAGER | 340 SEVEN SPRINGS WAY, SUITE 600 BRENTWOOD, TN 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2024-03-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-24 | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN 37027 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-24 | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN 37027 | No data |
| REINSTATEMENT | 2018-10-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-22 | CORPORATION SERVICE COMPANY | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CONVERSION | 2016-09-12 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P04000089804. CONVERSION NUMBER 500000163845 |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2024-03-28 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-01 |
| REINSTATEMENT | 2018-10-22 |
| ANNUAL REPORT | 2017-04-30 |
| Florida Limited Liability | 2016-09-12 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
