| Entity Name: | NATURECOAST PAIN ASSOCIATES, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Mar 2012 (13 years ago) |
| Document Number: | P12000030826 |
| FEI/EIN Number | 45-4974746 |
| Address: | 4225 W Menasha St, LECANTO, FL, 34461, US |
| Mail Address: | 4225 W Menasha St, LECANTO, FL, 34461, US |
| ZIP code: | 34461 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982953089 | 2012-09-05 | 2024-08-14 | 70 N LECANTO HWY, LECANTO, FL, 344619190, US | 70 N LECANTO HWY, LECANTO, FL, 344619190, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 352-527-4444 |
| Fax | 3527467829 |
Authorized person
| Name | CHRISTOPHER MARK FALLOWS |
| Role | PRESIDENT |
| Phone | 3525274444 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | GM283A |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DT1184 |
| Issuer | FLORIDA BLUE |
| Number | 003QU |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FALLOWS C. M. | Agent | 4225 W Menasha St, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| FALLOWS C. M. | President | 4225 W Menasha St, LECANTO, FL, 34461 |
| Name | Role | Address |
|---|---|---|
| Fallows Judith L | Secretary | 4225 W Menasha St, LECANTO, FL, 34461 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000065689 | GENTLE ANESTHESIA SPECIALISTS | ACTIVE | 2024-05-22 | 2029-12-31 | No data | 4225 W. MENASHA ST, LECANTO, FL, 34461 |
| G12000123789 | PAIN INSTITUTE OF CENTRAL FLORIDA | ACTIVE | 2012-12-21 | 2027-12-31 | No data | 70 N. LECANTO HWY., LECANTO, FL, 34461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-24 | 4225 W Menasha St, LECANTO, FL 34461 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-24 | 4225 W Menasha St, LECANTO, FL 34461 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-24 | 4225 W Menasha St, LECANTO, FL 34461 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-24 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-04-02 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-17 |
| ANNUAL REPORT | 2015-01-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
