| Entity Name: | SOUTHEAST INTERVENTIONAL PAIN SPECIALISTS, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Apr 2022 (3 years ago) |
| Document Number: | P22000031848 |
| FEI/EIN Number | 88-1789127 |
| Address: | 3781 SAN JOSE PLACE, UNIT 27, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 3781 SAN JOSE PLACE, UNIT 27, JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710618160 | 2022-06-17 | 2024-04-10 | 3750 SAN JOSE PL STE 35, JACKSONVILLE, FL, 322578861, US | 12276 SAN JOSE BLVD STE 210, JACKSONVILLE, FL, 322238631, US | |||||||||||||||
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| Phone | +1 904-717-9625 |
| Fax | 9046836499 |
Authorized person
| Name | KENNETH JOSEPH EADDY |
| Role | PHYSICIAN |
| Phone | 9047179625 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JAMAR D. JORDAN, P.A. | Agent | 11900 BISCAYNE BLVD, NORTH MIAMI, FL, 33181 |
| Name | Role | Address |
|---|---|---|
| EADDY KENNETH JDR | President | 3781 SAN JOSE PLACE, JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| JOHNSON DONNA | Treasurer | 3781 SAN JOSE PLACE, JACKSONVILLE, FL, 32257 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-02-10 |
| Domestic Profit | 2022-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
