| Entity Name: | MARION PAIN MANAGEMENT CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Aug 2001 (23 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P01000083895 |
| FEI/EIN Number | 593741570 |
| Address: | 1737 A SE 28TH LOOP, OCALA, FL, 34471-1079, US |
| Mail Address: | 1737 A SE 28TH LOOP, OCALA, FL, 34471-1079, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538258561 | 2006-10-11 | 2010-02-02 | PO BOX 917572, ORLANDO, FL, 328917572, US | 1737A SE 28TH LOOP, OCALA, FL, 344711079, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 888-877-3850 |
| Fax | 6313296951 |
| Phone | +1 352-622-1840 |
| Fax | 3526220137 |
Authorized person
| Name | DR. MANGALA SHETTY |
| Role | OWNER |
| Phone | 3526221840 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 254258700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHETTY MANGALA JDr. | Agent | 1737 A SE 28TH LOOP, OCALA, FL, 344711079 |
| Name | Role | Address |
|---|---|---|
| SHETTY MANGALA JDr. | pres | 1737 A SE 28TH LOOP, OCALA, FL, 344711079 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-09 | SHETTY, MANGALA J, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-08 | 1737 A SE 28TH LOOP, OCALA, FL 34471-1079 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-08 | 1737 A SE 28TH LOOP, OCALA, FL 34471-1079 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-02-08 | 1737 A SE 28TH LOOP, OCALA, FL 34471-1079 | No data |
| CANCEL ADM DISS/REV | 2008-06-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-04-09 |
| ANNUAL REPORT | 2014-03-13 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-02-08 |
| ANNUAL REPORT | 2011-03-16 |
| ANNUAL REPORT | 2010-02-03 |
| ANNUAL REPORT | 2009-02-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
