| Entity Name: | ULTIMA SPINE & PAIN LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Mar 2017 (8 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L17000066095 |
| Address: | 1507 S HIAWASSEE ROAD, 105, ORLANDO, FL, 32835, US |
| Mail Address: | 1507 S HIAWASSEE ROAD, 105, ORLANDO, FL, 32835, US |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407378862 | 2017-07-07 | 2017-07-07 | 1507 S HIAWASSEE RD STE 105, ORLANDO, FL, 328355706, US | 1507 S HIAWASSEE RD STE 105, ORLANDO, FL, 328355706, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 321-231-3408 |
Authorized person
| Name | SRIKIRAN POTHAMSETTY |
| Role | OWNER |
| Phone | 3212313408 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| POTHAMSETTY SRIKIRAN | Agent | 8625 SPINDLETOP DRIVE, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| POTHAMSETTY SRIKIRAN | Authorized Member | 8625 SPINDLETOP DRIVE, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| POTHAMSETTY REVATI | Manager | 8625 SPINDLETOP DRIVE, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2017-03-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
