| Entity Name: | FLORIDA PAIN CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Dec 1989 (35 years ago) |
| Document Number: | L38394 |
| FEI/EIN Number | 592983266 |
| Mail Address: | P.O. BOX 1626, OCALA, FL, 34478 |
| Address: | 2300 S. PINE AVE, SUITE C, OCALA, FL, 34471, US |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043204415 | 2005-08-31 | 2014-04-24 | PO BOX 1626, OCALA, FL, 344781626, US | 2300 S PINE AVE, SUITE B, OCALA, FL, 344715102, US | |||||||||||||||||||||||||
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| Phone | +1 352-873-6808 |
| Fax | 3528736808 |
| Phone | +1 352-861-4600 |
| Fax | 3522375437 |
Authorized person
| Name | DR. STEPHEN T. PYLES |
| Role | PRESIDENT |
| Phone | 3528736808 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 62484 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLORIDA PAIN CLINIC INC 401K PLAN | 2019 | 592983266 | 2020-05-20 | FLORIDA PAIN CLINIC INC | 8 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2020-05-19 |
| Name of individual signing | SUSAN NANETTE HATCH |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2020-05-19 |
| Name of individual signing | SUSAN NANETTE HATCH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| FLORIDA PAIN CLINIC, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| PYLES STEPHEN TDR. | President | 2300 S. PINE AVE, OCALA, FL, 34471 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
