| Entity Name: | PAIN SPECIALISTS OF MIAMI LAKES CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 May 2021 (4 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 27 Oct 2021 (3 years ago) |
| Document Number: | P21000048243 |
| FEI/EIN Number | 87-0982904 |
| Address: | 15600 NW 67TH AVE, SUITE 203, MIAMI LAKES, FL, 33014, US |
| Mail Address: | 15600 NW 167TH AVE, SUITE 203, MIAMI LAKES, FL, 33014, US |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295481976 | 2022-02-22 | 2022-02-22 | 15600 NW 67TH AVE STE 203, MIAMI LAKES, FL, 330142175, US | 15600 NW 67TH AVE STE 203, MIAMI LAKES, FL, 330142175, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 786-365-1492 |
| Fax | 3053972963 |
Authorized person
| Name | PABLO SMITH |
| Role | AUTHORIZED OFFICIAL |
| Phone | 7865620632 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| Is Primary | No |
| Taxonomy Code | 207XX0004X - Orthopaedic Foot and Ankle Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician |
| Is Primary | Yes |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | No |
| Taxonomy Code | 213ES0000X - Sports Medicine Podiatrist |
| Is Primary | No |
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| SMITH PABLO | Agent | 15600 NW 167TH AVE, Miami Lakes, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| SMITH PABLO | President | 15600 NW 67TH AVE STE 203, MIAMI LAKES, FL, 33014 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000018479 | TREE OF LYFE SPORTS MEDICINE | ACTIVE | 2022-02-14 | 2027-12-31 | No data | 2500 SW 117TH COURT, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-19 | 15600 NW 167TH AVE, 203, Miami Lakes, FL 33014 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-16 | 15600 NW 67TH AVE, SUITE 203, MIAMI LAKES, FL 33014 | No data |
| AMENDMENT | 2021-10-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| AMENDED ANNUAL REPORT | 2023-05-05 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-03-16 |
| Amendment | 2021-10-27 |
| Domestic Profit | 2021-05-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
