| Entity Name: | FL SPINE & MEDICAL CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Dec 2016 (8 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L16000231330 |
| FEI/EIN Number | 814774077 |
| Address: | 1799 Sunrise Blvd, CLEARWATER, FL, 33760, US |
| Mail Address: | 1799 Sunrise Blvd, CLEARWATER, FL, 33760, US |
| ZIP code: | 33760 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942746763 | 2017-01-18 | 2017-01-18 | 1531 S MISSOURI AVE, CLEARWATER, FL, 337562236, US | 1531 S MISSOURI AVE, CLEARWATER, FL, 337562236, US | |||||||||||||||||||
|
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| Phone | +1 727-799-2225 |
| Fax | 7277992226 |
Authorized person
| Name | DR. MARK KANTZLER |
| Role | MGR |
| Phone | 7277992225 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS5165 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WOOD BRANDON S | Agent | 1799 Sunrise Blvd, CLEARWATER, FL, 33760 |
| Name | Role | Address |
|---|---|---|
| Wood Brandon SDr. | Manager | 1799 Sunrise Blvd, CLEARWATER, FL, 33760 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-23 | 1799 Sunrise Blvd, CLEARWATER, FL 33760 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-23 | 1799 Sunrise Blvd, CLEARWATER, FL 33760 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-23 | 1799 Sunrise Blvd, CLEARWATER, FL 33760 | No data |
| LC STMNT OF RA/RO CHG | 2018-04-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-02 | WOOD, BRANDON S | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-29 |
| Florida Limited Liability | 2016-12-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
