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PALM BEACH PAIN INSTITUTE, INC.

Company Details

Entity Name: PALM BEACH PAIN INSTITUTE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 28 Jan 2002 (23 years ago)
Last Event: CANCEL ADM DISS/REV
Event Date Filed: 11 Sep 2007 (17 years ago)
Document Number: P02000009477
FEI/EIN Number 020539371
Address: 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL, 33484
Mail Address: 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL, 33484
ZIP code: 33484
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538423157 2012-06-28 2012-07-17 5130 LINTON BLVD, SUITE C-2, DELRAY BEACH, FL, 334846596, US 5130 LINTON BLVD, SUITE C-2, DELRAY BEACH, FL, 334846596, US

Contacts

Phone +1 561-499-7020
Fax 5614997942

Authorized person

Name MARCIE A MERSON
Role OWNER
Phone 5614997020

Taxonomy

Taxonomy Code 208VP0014X - Interventional Pain Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALM BEACH PAIN INSTITUTE, INC 401(K) PROFIT SHARING PLAN & TRUST 2023 020539371 2024-05-21 PALM BEACH PAIN INSTITUTE INC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 5614997020
Plan sponsor’s address 5130 LINTON BLVD - STE C2, DELRAY BEACH, FL, 33484

Signature of

Role Plan administrator
Date 2024-05-21
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
PALM BEACH PAIN INSTITUTE, INC 401(K) PROFIT SHARING PLAN & TRUST 2022 020539371 2023-04-27 PALM BEACH PAIN INSTITUTE INC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 5614997020
Plan sponsor’s address 5130 LINTON BLVD - STE C2, DELRAY BEACH, FL, 33484

Signature of

Role Plan administrator
Date 2023-04-27
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
PALM BEACH PAIN INSTITUTE, INC 401(K) PROFIT SHARING PLAN & TRUST 2021 020539371 2022-05-31 PALM BEACH PAIN INSTITUTE INC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 5614997020
Plan sponsor’s address 5130 LINTON BLVD - STE C2, DELRAY BEACH, FL, 33484

Signature of

Role Plan administrator
Date 2022-05-31
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
PALM BEACH PAIN INSTITUTE, INC 401(K) PROFIT SHARING PLAN & TRUST 2020 020539371 2021-06-04 PALM BEACH PAIN INSTITUTE INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 5614997020
Plan sponsor’s address 5130 LINTON BLVD - STE C2, DELRAY BEACH, FL, 33484

Signature of

Role Plan administrator
Date 2021-06-04
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
PALM BEACH PAIN INSTITUTE, INC 401(K) PROFIT SHARING PLAN & TRUST 2019 020539371 2020-06-23 PALM BEACH PAIN INSTITUTE INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 5614997020
Plan sponsor’s address 5130 LINTON BLVD - STE C2, DELRAY BEACH, FL, 33484

Signature of

Role Plan administrator
Date 2020-06-23
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MERSON MARCIE Agent 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL, 33484

Director

Name Role Address
MERSON MARCIE Director 5130 LINTON BLVD, SUITE C-2, DELRAY BEACH, FL, 33484

Events

Event Type Filed Date Value Description
CANCEL ADM DISS/REV 2007-09-11 No data No data
CHANGE OF PRINCIPAL ADDRESS 2007-09-11 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL 33484 No data
CHANGE OF MAILING ADDRESS 2007-09-11 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL 33484 No data
REGISTERED AGENT ADDRESS CHANGED 2007-09-11 5130 LINTON BLVD., SUITE C-2, DELRAY BEACH, FL 33484 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2006-09-15 No data No data
REINSTATEMENT 2004-12-28 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2003-09-19 No data No data

Documents

Name Date
ANNUAL REPORT 2025-01-05
ANNUAL REPORT 2024-01-07
ANNUAL REPORT 2023-01-03
ANNUAL REPORT 2022-01-02
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-03-06
ANNUAL REPORT 2019-01-16
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-23
ANNUAL REPORT 2016-01-28

Date of last update: 02 Feb 2025

Sources: Florida Department of State