| Entity Name: | NEUROSURGICAL SPINE INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Oct 2019 (5 years ago) |
| Document Number: | L19000253935 |
| FEI/EIN Number | 84-3280549 |
| Address: | 2484 Caring Way, Port Charlotte, FL, 33952, US |
| Mail Address: | 4070 LEA MARIE ISLAND DR, PORT CHARLOTTE, FL, 33952 |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174166201 | 2019-10-22 | 2022-01-06 | 2484 CARING WAY UNIT C, PORT CHARLOTTE, FL, 339525306, US | 2484 CARING WAY UNIT C, PORT CHARLOTTE, FL, 339525306, US | |||||||||||||||
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| Phone | +1 941-483-4000 |
| Fax | 9414801086 |
Authorized person
| Name | MARAT GRIGOROV |
| Role | MANAGER |
| Phone | 9414834000 |
Taxonomy
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NEUROSURGICAL SPINE INSTITUTE 401(K) PLAN | 2023 | 843280549 | 2024-07-23 | NEUROSURGICAL SPINE INSTITUTE | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-23 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 9414834000 |
| Plan sponsor’s address | 2484 CARING WAY - UNIT C, PORT CHARLOTTE, FL, 33952 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-18 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GRIGOROV MARAT V | Agent | 4070 LEA MARIE ISLAND DR, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| MINOSYAN TAMARA | Manager | 4070 LEA MARIE ISLAND DR, PORT CHARLOTTE, FL, 33952 |
| GRIGOROV MARAT | Manager | 4070 LEA MARIE ISLAND DR, PORT CHARLOTTE, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-22 | 2484 Caring Way, UNIT C, Port Charlotte, FL 33952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-03-22 |
| ANNUAL REPORT | 2021-01-22 |
| Florida Limited Liability | 2019-10-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
