| Entity Name: | SPINE CENTER OF FL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Jul 2019 (6 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 05 Oct 2022 (2 years ago) |
| Document Number: | L19000189166 |
| FEI/EIN Number | 84-2659345 |
| Address: | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 |
| Mail Address: | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861043929 | 2019-09-20 | 2019-09-20 | 11921 ROCKVILLE PIKE STE 505, ROCKVILLE, MD, 208522758, US | 9400 BONITA BEACH RD SE STE 101, BONITA SPRINGS, FL, 341354520, US | |||||||||||||||||||||
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| Phone | +1 301-945-5111 |
| Phone | +1 239-333-1177 |
| Fax | 2393331169 |
Authorized person
| Name | DOUGLAS W WISOR |
| Role | OFFICER |
| Phone | 7039275772 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Mahaney, Eugene D., Jr. | Member | 5280 Corporate Drive, Suite C-250 Frederick, MD 21703 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-28 | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-28 | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-05 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-05 | C T CORPORATION SYSTEM | No data |
| LC STMNT OF RA/RO CHG | 2022-10-05 | No data | No data |
| LC AMENDMENT | 2020-02-10 | No data | No data |
| LC AMENDMENT | 2020-02-07 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-28 |
| ANNUAL REPORT | 2023-04-12 |
| CORLCRACHG | 2022-10-05 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-03-19 |
| LC Amendment | 2020-02-07 |
| Florida Limited Liability | 2019-07-23 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
