| Entity Name: | INTERVENTIONAL SPINE AND PAIN INSTITUTE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
INTERVENTIONAL SPINE AND PAIN INSTITUTE, L.L.C. is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 29 Dec 2021 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Mar 2022 (3 years ago) |
| Document Number: | L22000007931 |
| FEI/EIN Number |
874307659
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 777 37 ST STE C-101, VERO BEACH, FL, 32960 |
| Mail Address: | 777 37 ST STE C-101, VERO BEACH, FL, 32960 |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396526901 | 2023-10-10 | 2024-02-27 | 777 37TH ST STE C101, VERO BEACH, FL, 329607301, US | 5200 BABCOCK ST NE STE 111, PALM BAY, FL, 329054639, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 772-360-1997 |
| Fax | 7724923541 |
Authorized person
| Name | PHAEDRA LUND SHUDRA |
| Role | CREDENTIALING AND CONTRACTING SPECI |
| Phone | 8137854861 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | No |
| Taxonomy Code | 207RH0002X - Hospice and Palliative Medicine (Internal Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ESPOSITO MICHAEL F | Manager | 777 37 ST STE C-101, VERO BEACH, FL, 32960 |
| GASSMAN ALAN SESQ. | Agent | 1245 COURT STREET, CLEARWATER, FL, 33756 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2022-03-18 | - | - |
| LC AMENDMENT | 2022-01-21 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-21 | 777 37 ST STE C-101, VERO BEACH, FL 32960 | - |
| CHANGE OF MAILING ADDRESS | 2022-01-21 | 777 37 ST STE C-101, VERO BEACH, FL 32960 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-01-09 |
| LC Amendment | 2022-03-18 |
| LC Amendment | 2022-01-21 |
| Florida Limited Liability | 2021-12-29 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
