| Entity Name: | FLORIDA NEUROSURGERY AND SPINE CENTER PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Dec 2022 (2 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 Nov 2024 (3 months ago) |
| Document Number: | P22000092640 |
| FEI/EIN Number | 92-1337853 |
| Address: | 155 CRYSTAL BEACH DR, 200, DESTIN, FL, 32541, US |
| Mail Address: | 155 CRYSTAL BEACH DR, 200, DESTIN, FL, 32541, US |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396458329 | 2023-01-04 | 2024-05-01 | 155 CRYSTAL BEACH DR STE 200, DESTIN, FL, 325413588, US | 155 CRYSTAL BEACH DR STE 200, DESTIN, FL, 325413588, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 850-353-2055 |
| Fax | 8553446080 |
Authorized person
| Name | DR. TIMOTHY R MONROE |
| Role | PRESIDENT; OWNER |
| Phone | 8503532055 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207T00000X - Neurological Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| McGee BOBBY JO | Agent | 155 CRYTSAL BEACH DR, DESTIN, FL, 32541 |
| Name | Role | Address |
|---|---|---|
| MONROE TIMOTHY | Owne | 155 CRYSTAL BEACH DR, DESTIN, FL, 32541 |
| Name | Role | Address |
|---|---|---|
| Lechner Eric | Chief Executive Officer | 155 Crystal Beach Dr, DESTIN, FL, 32541 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000018558 | MANDARIN INTERVENTIONAL PAIN | ACTIVE | 2023-02-08 | 2028-12-31 | No data | 155 CRYSTAL BEACH DR, 200, DESTIN, FL, 32541 |
| G23000014064 | WHITE SANDS SPINE AND NEUROSURGERY | ACTIVE | 2023-01-30 | 2028-12-31 | No data | 155 CRYSTAL BEACH DR, 200, DESTIN, FL, 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-11-20 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-11-20 | McGee, BOBBY JO | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REINSTATEMENT | 2023-11-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-11-20 |
| REINSTATEMENT | 2023-11-15 |
| Domestic Profit | 2022-12-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
