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  5. CHARLOTTE PAIN MANAGEMENT CENTER, INC.

CHARLOTTE PAIN MANAGEMENT CENTER, INC.

Company Details

Entity Name: CHARLOTTE PAIN MANAGEMENT CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 09 Jul 2008 (17 years ago)
Document Number: P08000065475
FEI/EIN Number 262947510
Address: 3109 TAMIAMI TRAIL,, SUITE 3, PORT CHARLOTTE, FL, 33952
Mail Address: 3109 TAMIAMI TRAIL, SUITE #3, PORT CHARLOTTE, FL, 33952
ZIP code: 33952
County: Charlotte
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275797714 2008-07-14 2019-07-03 3109 TAMIAMI TRL, UNIT 3, PORT CHARLOTTE, FL, 339528046, US 3109 TAMIAMI TRL, UNIT 3, PORT CHARLOTTE, FL, 339528046, US

Contacts
Phone +1 941-629-3000
Fax 9416296711

Authorized person
Name MS. NANCY J HARRIS
Role OWNER
Phone 9416293000

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
Is Primary Yes
Taxonomy Code 261QP3300X - Pain Clinic/Center
Is Primary No

Other Provider Identifiers
Issuer FLORIDA LICENSE
Number RN1855592
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2012 262947510 2013-04-17 CHARLOTTE PAIN MANAGEMENT CENTER 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Signature of
Role Plan administrator
Date 2013-04-17
Name of individual signing SUE L WILHITE
Valid signature Filed with authorized/valid electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2011 262947510 2012-03-14 CHARLOTTE PAIN MANAGEMENT CENTER 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2012-03-14
Name of individual signing SUE L WILHITE
Valid signature Filed with authorized/valid electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2010 262947510 2011-05-27 CHARLOTTE PAIN MANAGEMENT CENTER 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2011-05-27
Name of individual signing SUE L WILHITE
Valid signature Filed with authorized/valid electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-07-30 CHARLOTTE PAIN MANAGEMENT CENTER 11
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-06-29 CHARLOTTE PAIN MANAGEMENT CENTER 11
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-08-17 CHARLOTTE PAIN MANAGEMENT CENTER 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-17
Name of individual signing NANCY HARRIS
Valid signature Filed with authorized/valid electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-07-30 CHARLOTTE PAIN MANAGEMENT CENTER 11
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-07-30 CHARLOTTE PAIN MANAGEMENT CENTER 11
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature
CHARLOTTE PAIN MANAGEMENT CENTER 401K PLAN 2009 262947510 2010-07-29 CHARLOTTE PAIN MANAGEMENT CENTER 11
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 541990
Sponsor’s telephone number 9416293000
Plan sponsor’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952

Plan administrator’s name and address
Administrator’s EIN 262947510
Plan administrator’s name CHARLOTTE PAIN MANAGEMENT CENTER
Plan administrator’s address 3109 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952
Administrator’s telephone number 9416293000

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-07-29
Name of individual signing NANCY HARRIS
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
Fils Jessica L Agent 3109 TAMIAMI TRAIL,, PORT CHARLOTTE, FL, 33952

President

Name Role Address
HARRIS NANCY J President 3109 TAMIAMI TRAIL, SUITE 3, PORT CHARLOTTE, FL, 33952

Vice President

Name Role Address
Fils Jessica L Vice President 3109 TAMIAMI TRAIL,, PORT CHARLOTTE, FL, 33952

Secretary

Name Role Address
Amilcar Serena Secretary 3109 TAMIAMI TRAIL,, PORT CHARLOTTE, FL, 33952

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-04-24 Fils, Jessica L No data
REGISTERED AGENT ADDRESS CHANGED 2017-04-04 3109 TAMIAMI TRAIL,, SUITE 3, PORT CHARLOTTE, FL 33952 No data
CHANGE OF PRINCIPAL ADDRESS 2011-03-16 3109 TAMIAMI TRAIL,, SUITE 3, PORT CHARLOTTE, FL 33952 No data
CHANGE OF MAILING ADDRESS 2011-03-16 3109 TAMIAMI TRAIL,, SUITE 3, PORT CHARLOTTE, FL 33952 No data

Documents

Name Date
ANNUAL REPORT 2024-04-24
ANNUAL REPORT 2023-03-28
ANNUAL REPORT 2022-03-31
ANNUAL REPORT 2021-03-30
ANNUAL REPORT 2020-01-28
ANNUAL REPORT 2019-04-09
ANNUAL REPORT 2018-03-08
ANNUAL REPORT 2017-04-04
ANNUAL REPORT 2016-04-22
ANNUAL REPORT 2015-02-03

Related by officers

HARRIS NANCY J

CHARLOTTE PAIN CLINIC, INCORPORATED LA ROSE PLAZA, LLC GOFLIGHT AVIATION SERVICES INC. CHARLOTTE PAIN CENTER, INC.

Fils Jessica L

CHARLOTTE PAIN CENTER, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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