| Entity Name: | MIS NEUROSPINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jan 2022 (3 years ago) |
| Document Number: | L22000075582 |
| FEI/EIN Number | 88-0936508 |
| Address: | 12061 NOKOMIS COURT, FORT MYERS, FL, 33905, US |
| Mail Address: | 12061 NOKOMIS COURT, FORT MYERS, FL, 33905, US |
| ZIP code: | 33905 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629766969 | 2023-04-25 | 2023-04-25 | 1711 AMAZING WAY STE 209, OCOEE, FL, 347613491, US | 12468 BRANTLEY COMMONS CT, FORT MYERS, FL, 339075663, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 239-236-8933 |
| Fax | 4076502731 |
Authorized person
| Name | DR. CURTIS LEE BEAUREGARD |
| Role | OWNER |
| Phone | 2392368933 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BEAUREGARD CURTIS | Agent | 12061 NOKOMIS CT, FORT MYERS, FL, 33905 |
| Name | Role | Address |
|---|---|---|
| BEAUREGARD CURTIS | Manager | 12061 NOKOMIS COURT, FORT MYERS, FL, 33905 |
| Name | Role |
|---|---|
| CLBNEURO, PLLC | Authorized Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-04-10 |
| Florida Limited Liability | 2022-01-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
