| Entity Name: | EXCEL PAIN AND SPINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Aug 2020 (5 years ago) |
| Document Number: | P20000060639 |
| FEI/EIN Number | 852593357 |
| Address: | 771 Cypress Village Blvd, Sun City Center, FL, 33573, US |
| Mail Address: | 771 Cypress Village Blvd, Sun City Center, FL, 33573, US |
| ZIP code: | 33573 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366207649 | 2024-02-16 | 2024-02-16 | 3501 BESSIE COLEMAN BLVD UNIT 25201, TAMPA, FL, 336229130, US | 1749 6TH ST NW, WINTER HAVEN, FL, 338812301, US | |||||||||||||||
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| Phone | +1 813-701-5804 |
| Fax | 8132917615 |
Authorized person
| Name | DR. ARPIT A PATEL |
| Role | OWNER |
| Phone | 8137015804 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EXCEL PAIN AND SPINE 401(K) PLAN | 2023 | 852593357 | 2024-05-07 | EXCEL PAIN AND SPINE | 9 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-07 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8137015804 |
| Plan sponsor’s address | 771 CYPRESS VILLAGE BLVD, SUN CITY CENTER, FL, 33573 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-30 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Patel Arpit Member | Agent | 771 Cypress Village Blvd, Sun City Center, FL, 33573 |
| Name | Role | Address |
|---|---|---|
| REEVES COREY MD MBA | Manager | 2511 North Riverside Drive, Tampa, FL, 33602 |
| PATEL ARPIT DO | Manager | 121 BISCAYNE AVE, TAMPA, FL, 33606 |
| Shah, MD Neal | Manager | 3818 W. Vasconia St, Tampa, FL, 33629 |
| Jassal, MD Navdeep MD MBA | Manager | 2906 W Euclid, Tampa, FL, 33629 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000089423 | SPINE & PAIN INSTITUTE OF FLORIDA | ACTIVE | 2024-07-26 | 2029-12-31 | No data | 771 CYPRESS VILLAGE BLVD, SUN CITY CENTER, FL, 33606 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-20 | 771 Cypress Village Blvd, Sun City Center, FL 33573 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-06-08 | Patel, Arpit, Member | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-05-01 | 771 Cypress Village Blvd, Sun City Center, FL 33573 | No data |
| CHANGE OF MAILING ADDRESS | 2021-05-01 | 771 Cypress Village Blvd, Sun City Center, FL 33573 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-01-28 |
| AMENDED ANNUAL REPORT | 2021-06-08 |
| ANNUAL REPORT | 2021-05-01 |
| Domestic Profit | 2020-08-10 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
