| Entity Name: | 3D SPORTS MEDICINE AND JOINT CENTER, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Jan 2013 (12 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 07 Oct 2024 (4 months ago) |
| Document Number: | P13000005762 |
| FEI/EIN Number | 46-1792753 |
| Address: | 620 Classic Court, Melbourne, FL, 32940, US |
| Mail Address: | 620 Classic Court, Melbourne, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316351372 | 2014-06-18 | 2023-11-03 | 141 COCOUNUT DR, INDIALANTIC, FL, 329032607, US | 141 COCONUT DR, INDIALANTIC, FL, 329032607, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 321-610-8939 |
| Fax | 3216228728 |
Authorized person
| Name | DR. DAVID E DOMINGUEZ |
| Role | OWNER |
| Phone | 3216108939 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | ME110378 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician |
| License Number | ME110378 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012845800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| INC DEC CONSULTANT | Agent | 1515 Indian River Blvd., Vero Beach, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| DOMINGUEZ DAVID E | President | 620 Classic Court, Melbourne, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000121860 | 3D SPORTS MEDICINE & ORTHOPAEDIC CENTER | ACTIVE | 2023-10-02 | 2028-12-31 | No data | 141 COCONUT DRIVE, INDIALANTIC, FL, 32903 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-10-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-07 | 620 Classic Court, Suite 104, Melbourne, FL 32940 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-07 | 620 Classic Court, Suite 104, Melbourne, FL 32940 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-18 | INC, DEC CONSULTANTS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-18 | 1515 Indian River Blvd., A210, Vero Beach, FL 32960 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-10-07 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-07-15 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-07-19 |
| ANNUAL REPORT | 2019-01-17 |
| ANNUAL REPORT | 2018-03-02 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-07-08 |
| ANNUAL REPORT | 2015-03-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
