| Entity Name: | SOUTHERN INTERVENTIONAL PAIN CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Oct 2017 (7 years ago) |
| Document Number: | M17000008853 |
| FEI/EIN Number | 47-4062909 |
| Address: | 619 sw baya drive, Suite 102, Lake City, FL, 32025, US |
| Mail Address: | 615 S. HANSELL STREET, THOMASVILLE, GA, 31792, US |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | GEORGIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407315948 | 2019-03-14 | 2020-01-31 | 615 S HANSELL ST, THOMASVILLE, GA, 317925556, US | 1931 WELBY WAY STE 4, TALLAHASSEE, FL, 323084473, US | |||||||||||||||||||||||
|
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| Phone | +1 229-226-2234 |
| Fax | 2292262237 |
| Phone | +1 850-404-9400 |
| Fax | 8553131262 |
Authorized person
| Name | DR. MAXIMILIAN SHAHRYAR SHOKAT |
| Role | MANAGING MEMBER |
| Phone | 2292262234 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Greene Dominique | Agent | 619 SW BAYA DRIVE, SUITE 102, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| SHOKAT MAX D.O. | Managing Member | 615 S. HANSELL STREET, THOMASVILLE, GA, 31792 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-02-20 | Greene, Dominique | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-20 | 619 SW BAYA DRIVE, SUITE 102, LAKE CITY, FL 32025 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-11 | 619 sw baya drive, Suite 102, Lake City, FL 32025 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-02-20 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-11 |
| ANNUAL REPORT | 2019-02-25 |
| ANNUAL REPORT | 2018-03-12 |
| Foreign Limited | 2017-10-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
