| Entity Name: | SPACE COAST SPINE AND PAIN INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Dec 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 22 Feb 2021 (4 years ago) |
| Document Number: | L20000004554 |
| FEI/EIN Number | 84-4204158 |
| Address: | 205 EAST NASA BOULEVARD, MELBOURNE, FL, 32901, US |
| Mail Address: | 205 EAST NASA BOULEVARD, MELBOURNE, FL, 32901, US |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093388217 | 2021-07-24 | 2021-07-24 | 285 LANSING ISLAND DR, INDIAN HARBOUR BEACH, FL, 329375102, US | 205 E NASA BLVD STE 200, MELBOURNE, FL, 329011954, US | |||||||||||||||||
|
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| Phone | +1 321-361-5619 |
Authorized person
| Name | SONYA WARNICK |
| Role | ADMINISTRATOR |
| Phone | 3214325480 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPACE COAST SPINE AND PAIN INSTITUTE 401(K) PROFIT SHARING PLAN | 2022 | 844204158 | 2023-11-08 | SPACE COAST SPINE AND PAIN INSTITUTE, LLC | 3 | |||||||||||||
|
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| Name | Role | Address |
|---|---|---|
| PATEL MARKAND J | Agent | 285 LANSING ISLAND DRIVE, INDIAN HARBOR BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| PATEL MARKAND J | Manager | 285 LANSING ISLAND DRIVE, INDIAN HARBOR BEACH, FL, 32937 |
| STEPHENS WILLIAM G | Manager | 1508 PINE STREET, MELBOURNE BEACH, FL, 32951 |
| ALVAREZ JOSE AIII | Manager | 2585 WOODS LANE, MELBOURNE, FL, 32934 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-07-28 | 205 EAST NASA BOULEVARD, MELBOURNE, FL 32901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-26 | 205 EAST NASA BOULEVARD, MELBOURNE, FL 32901 | No data |
| REINSTATEMENT | 2021-02-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-02-22 | PATEL, MARKAND J | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-12 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-03-09 |
| REINSTATEMENT | 2021-02-22 |
| Florida Limited Liability | 2019-12-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
