| Entity Name: | PAIN AND SUPPORTIVE CARE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Apr 2015 (10 years ago) |
| Document Number: | P15000035979 |
| FEI/EIN Number | 47-3791093 |
| Address: | 13801 Bruce B. Downs Blvd, Suite 406, Tampa, FL, 33613, US |
| Mail Address: | 13801 Bruce B. Downs Blvd, Suite 406, Tampa, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023467974 | 2016-06-10 | 2016-06-10 | 6612 THORNTON PALMS DR, TAMPA, FL, 336475104, US | 6612 THORNTON PALMS DR, TAMPA, FL, 336475104, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 813-399-2128 |
| Fax | 7272458661 |
Authorized person
| Name | DR. JOSE E SARRIA |
| Role | PRESIDENT |
| Phone | 8133992128 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAIN AND SUPPORTIVE CARE, PA 401(K) PLAN | 2022 | 473791093 | 2023-10-16 | PAIN AND SUPPORTIVE CARE, PA | 11 | |||||||||||||||||||||
|
||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2023-10-16 |
| Name of individual signing | KELLY MCDOWELL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8134440989 |
| Plan sponsor’s address | 13801 BRUCE B. DOWNS BLVD., SUITE 406, TAMPA, FL, 33613 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8134440989 |
| Plan sponsor’s address | 13801 BRUCE B. DOWNS BLVD., SUITE 406, TAMPA, FL, 33613 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8134440989 |
| Plan sponsor’s address | 13801 BRUCE B. DOWNS BLVD., SUITE 406, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| Dom Law, P.A. | Agent | 1814 N. 15th Street, Tampa, FL, 33605 |
| Name | Role | Address |
|---|---|---|
| Sarria Jose EDR. | President | 17233 Emerald Chase Drive, Tampa, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| Sarria Jose EDR. | Secretary | 17233 Emerald Chase Drive, Tampa, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| Sarria Jose EDR. | Treasurer | 17233 Emerald Chase Drive, Tampa, FL, 33647 |
| Name | Role |
|---|---|
| DOM LAW, PA | Auth |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000118878 | ASPIRE PAIN RELIEF INSTITUTE | EXPIRED | 2019-11-04 | 2024-12-31 | No data | 6612 THORNTON PALMS DRIVE, TAMPA, FL, 33647 |
| G17000036160 | THE PEREGRINE INSTITUTE | ACTIVE | 2017-04-04 | 2027-12-31 | No data | 13801 BRUCE B. DOWNS BOULEVARD, SUITE 406, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-30 | 13801 Bruce B. Downs Blvd, Suite 406, Tampa, FL 33613 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-30 | 13801 Bruce B. Downs Blvd, Suite 406, Tampa, FL 33613 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-30 | Dom Law, P.A. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 1814 N. 15th Street, Tampa, FL 33605 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-01-08 |
| AMENDED ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-04-29 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
