| Entity Name: | VERITAS INTERVENTIONAL PAIN & SPINE INSTITUTE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Jul 2017 (8 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L17000153136 |
| FEI/EIN Number | 82-2212005 |
| Address: | 2209 NORTH BLVD, SUITE A, DAVENPORT, FL, 33837, US |
| Mail Address: | 13242 FOX GLOVE STREET, WINTER GARDEN, FL, 34787, US |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295258051 | 2017-07-24 | 2017-09-20 | 13242 FOX GLOVE ST, WINTER GARDEN, FL, 347874717, US | 2209 NORTH BLVD W STE A, DAVENPORT, FL, 338378903, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 888-488-2702 |
| Phone | +1 863-679-8000 |
| Fax | 8636798008 |
Authorized person
| Name | DR. NARENDREN NARAYANASAMY |
| Role | MD |
| Phone | 8636798000 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | 2012028529 |
| State | MO |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 14Z0T |
| State | FL |
| Issuer | MEDICAID |
| Number | 031919600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NARAYANASAMY NARENDREN | Agent | 13242 FOX GLOVE STREET, WINTER GARDEN, FL, 34787 |
| Name | Role | Address |
|---|---|---|
| NARAYANASAMY NARENDREN | Authorized Member | 13242 FOX GLOVE STREET, WINTER GARDEN, FL, 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-03-18 |
| ANNUAL REPORT | 2018-03-14 |
| Florida Limited Liability | 2017-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
