| Entity Name: | ORTHO-SPINE CARE AMERICA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Aug 2017 (8 years ago) |
| Document Number: | L17000165581 |
| FEI/EIN Number | 82-2377266 |
| Address: | 1260 37TH STREET, UNIT 102, VERO BEACH, FL, 32960 |
| Mail Address: | PO Box 643191, VERO BEACH, FL, 32964, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407375744 | 2017-09-19 | 2022-07-21 | 1260 37TH ST STE 102, VERO BEACH, FL, 329606567, US | 1260 37TH ST STE 102, VERO BEACH, FL, 329606567, US | |||||||||||||
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| Phone | +1 772-213-9800 |
Authorized person
| Name | ADRIANNA VILLARREAL |
| Role | CREDENTIALING MANAGER |
| Phone | 2142956703 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ORTHO SPINE CARE AMERICA PLLC 401(K) PROFIT SHARING PLAN & TRUST | 2021 | 822377266 | 2022-04-07 | ORTHO SPINE CARE AMERICA PLLC | 6 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-04-07 |
| Name of individual signing | OMAR DAVID HUSSAMY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7722139800 |
| Plan sponsor’s address | 1260 37TH STREET, SUITE #102, VERO BEACH, FL, 32960 |
Signature of
| Role | Plan administrator |
| Date | 2021-05-25 |
| Name of individual signing | OMAR DAVID HUSSAMY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7722139800 |
| Plan sponsor’s address | 1260 37TH STREET, SUITE #102, VERO BEACH, FL, 32960 |
Signature of
| Role | Plan administrator |
| Date | 2020-06-19 |
| Name of individual signing | OMAR D. HUSSAMY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7722139800 |
| Plan sponsor’s address | 1260 37TH STREET, SUITE #102, VERO BEACH, FL, 32960 |
Signature of
| Role | Plan administrator |
| Date | 2019-04-11 |
| Name of individual signing | MICHELLE CLOUGH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GARRIS CHARLES E | Agent | 819 BEACHLAND BOULEVARD, VERO BEACH, FL, 32963 |
| Name | Role | Address |
|---|---|---|
| HUSSAMY OMAR DMD | Manager | 1260 37TH STREET, VERO BEACH, FL, 32960 |
| ATWATER JOHN GMD | Manager | 1260 37TH STREET, VERO BEACH, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-13 | 1260 37TH STREET, UNIT 102, VERO BEACH, FL 32960 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-03-04 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-02-18 |
| ANNUAL REPORT | 2019-02-28 |
| ANNUAL REPORT | 2018-02-21 |
| Florida Limited Liability | 2017-08-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
