| Entity Name: | REGENETICS HEALTH INSTITUTE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Aug 2002 (22 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 26 Oct 2016 (8 years ago) |
| Document Number: | P02000089941 |
| FEI/EIN Number | 331018616 |
| Address: | 988 E. OSCEOLA PKWY, KISSIMMEE, FL, 34744, US |
| Mail Address: | 8815 Conroy Windermere Road #203, Orlando, FL, 32835, US |
| ZIP code: | 34744 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1366458978 | 2006-08-01 | 2016-11-01 | 8815 CONROY WINDERMERE RD, #203, ORLANDO, FL, 328353129, US | 988 E OSCEOLA PKWY, KISSIMMEE, FL, 347441615, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-483-4079 |
| Fax | 4075728642 |
Authorized person
| Name | CARLOS JOSE PLACER |
| Role | PHYSICIAN |
| Phone | 4079334441 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME82389 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | ME82389 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | ME82389 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 2940027 |
| Issuer | AETNA |
| Number | 2940027 |
| State | FL |
| Issuer | TRICARE |
| Number | 311018616 |
| Issuer | CIGNA |
| Number | 5053308 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 111601 |
| Issuer | BCBS |
| Number | 03009 |
| Issuer | MEDICAID |
| Number | 261952100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PLACER CARLOS J | Agent | 8815 Conroy Windermere Road #203, Orlando, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| PLACER CARLOS J | President | 988 E. OSCEOLA PKWY, KISSIMMEE, FL, 34744 |
| Name | Role | Address |
|---|---|---|
| PLACER CARLOS J | Treasurer | 988 E. OSCEOLA PKWY, KISSIMMEE, FL, 34744 |
| Name | Role | Address |
|---|---|---|
| PLACER CARLOS J | Director | 988 E. OSCEOLA PKWY, KISSIMMEE, FL, 34744 |
| Name | Role | Address |
|---|---|---|
| DIAZ YAZMIN | Vice President | 988 E. OSCEOLA PKWY, KISSIMMEE, FL, 34744 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-18 | 8815 Conroy Windermere Road #203, Orlando, FL 32835 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-18 | 988 E. OSCEOLA PKWY, KISSIMMEE, FL 34744 | No data |
| AMENDMENT AND NAME CHANGE | 2016-10-26 | REGENETICS HEALTH INSTITUTE, PA | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-10-26 | 988 E. OSCEOLA PKWY, KISSIMMEE, FL 34744 | No data |
| NAME CHANGE AMENDMENT | 2015-06-01 | REGENETICS PAIN INSTITUTE, P.A. | No data |
| REGISTERED AGENT NAME CHANGED | 2015-05-26 | PLACER, CARLOS J | No data |
| REINSTATEMENT | 2015-05-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2010-09-20 | FLORIDA SPINE SPORTS & REHABILITATION, P.A. | No data |
| AMENDMENT | 2004-12-02 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-26 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-02-07 |
| Amendment and Name Change | 2016-10-26 |
| ANNUAL REPORT | 2016-08-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
