| Entity Name: | SPINE CIN OF WEST PALM, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Dec 2017 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Oct 2019 (5 years ago) |
| Document Number: | L17000259896 |
| FEI/EIN Number | 82-3859076 |
| Address: | 4440 PGA BOULEVARD, PALM BEACH GARDENS, FL, 33410, US |
| Mail Address: | 4440 PGA BOULEVARD, PALM BEACH GARDENS, FL, 33410, US |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275041147 | 2018-01-13 | 2020-02-14 | 102 WOODMONT BLVD STE 350, NASHVILLE, TN, 372052216, US | 4440 PGA BLVD # 600A, PALM BEACH GARDENS, FL, 334106539, US | |||||||||||||||||||||||
|
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| Phone | +1 615-386-0064 |
| Fax | 6153860067 |
Authorized person
| Name | EDWARD LELAND HUTTON EADIE |
| Role | PE SPECIALIST |
| Phone | 6157332064 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| State | FL |
| Is Primary | No |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| CARE OF FL MSO, LLC | Manager |
| Name | Role | Address |
|---|---|---|
| Hannon John | Auth | 102 Woodmont Blvd, Nashville, TN, 37205 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-19 | 4440 PGA BOULEVARD, SUITE 600A, PALM BEACH GARDENS, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-19 | 4440 PGA BOULEVARD, SUITE 600A, PALM BEACH GARDENS, FL 33410 | No data |
| REINSTATEMENT | 2019-10-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-09 | CORPORATION SERVICE COMPANY | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| LC STMNT OF RA/RO CHG | 2019-07-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-07-25 | 1201 HAYS ST, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-02-19 |
| REINSTATEMENT | 2019-10-09 |
| CORLCRACHG | 2019-07-25 |
| ANNUAL REPORT | 2018-06-28 |
| Florida Limited Liability | 2017-12-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
