| Entity Name: | PALM BEACH PAIN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Jan 2017 (8 years ago) |
| Document Number: | L17000011638 |
| FEI/EIN Number | 81-5044966 |
| Address: | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 |
| Mail Address: | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 |
| ZIP code: | 33418 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386183549 | 2017-02-20 | 2017-02-20 | 5610 PGA BLVD STE 210, PALM BEACH GARDENS, FL, 334183838, US | 5610 PGA BLVD STE 210, PALM BEACH GARDENS, FL, 334183838, US | |||||||||||||||||||||||||
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| Phone | +1 561-781-8010 |
| Fax | 5617818020 |
Authorized person
| Name | DR. RICARDO A LEANO |
| Role | PRESIDENT |
| Phone | 5617818010 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| License Number | ME87536 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015251200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Leano, Ricardo A | Agent | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 |
| Name | Role | Address |
|---|---|---|
| LEANO, VILMA | Authorized Member | 5610 PGA BLVD.,, SUITE 210 PALM BEACH GARDENS, FL 33418 |
| LEANO, RICARDO A | Authorized Member | 5610 PGA BLVD.,, SUITE 210 PALM BEACH GARDENS, FL 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-22 | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-22 | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-22 | Leano, Ricardo A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-22 | 5610 PGA BLVD.,, SUITE 210, PALM BEACH GARDENS, FL 33418 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-02-05 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-04-22 |
| Florida Limited Liability | 2017-01-13 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
