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INTERVENTIONAL SPINE AND PAIN INSTITUTE, L.L.C. - Florida Company Profile

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Company Details

Entity Name: INTERVENTIONAL SPINE AND PAIN INSTITUTE, L.L.C.
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 29 Dec 2021 (4 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 18 Mar 2022 (3 years ago)
Document Number: L22000007931
FEI/EIN Number 874307659
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
City: Vero Beach
County: Indian River
Place of Formation: FLORIDA

Key Officers & Management

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

National Provider Identifier

NPI Number:
1396526901
Certification Date:
2024-02-27

Authorized Person:

Name:
PHAEDRA LUND SHUDRA
Role:
CREDENTIALING AND CONTRACTING SPECI
Phone:

Taxonomy:

Selected Taxonomy:
207L00000X - Anesthesiology Physician
Is Primary:
No
Selected Taxonomy:
207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary:
No
Selected Taxonomy:
207RH0002X - Hospice and Palliative Medicine (Internal Medicine) Physician
Is Primary:
No
Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
No
Selected Taxonomy:
208VP0000X - Pain Medicine Physician
Is Primary:
No

Contacts:

Fax:
7724923541

Events

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 -

Documents

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

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Date of last update: 01 Aug 2025

Sources: Florida Department of State