| Entity Name: | TOTAL PAIN CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 05 Dec 1995 (29 years ago) |
| Date of dissolution: | 22 Sep 2000 (24 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2000 (24 years ago) |
| Document Number: | P95000093097 |
| FEI/EIN Number | 65-0626236 |
| Address: | 440 EAST SAMPLE ROAD #101, POMPANO BEACH, FL 33064 |
| Mail Address: | 440 EAST SAMPLE ROAD #101, POMPANO BEACH, FL 33064 |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932229010 | 2007-03-30 | 2008-06-18 | 440 E SAMPLE RD, SUITE 101, POMPANO BEACH, FL, 330644444, US | 440 E SAMPLE RD, SUITE 101, POMPANO BEACH, FL, 330644444, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-788-9003 |
| Fax | 9547889631 |
Authorized person
| Name | ADEL AYAD KALLINI |
| Role | PROVIDERPHYSCIAN |
| Phone | 9547889003 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME32795 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP |
| Number | 208173 |
| State | FL |
| Issuer | MEDICAID |
| Number | 267476900 |
| State | FL |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 021477 |
| State | FL |
| Issuer | CARE PLUS |
| Number | 1013802 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KALLINI, ADEL | Agent | 440 E SAMPLE RD, #101, POMPANO BCH, FL 33064 |
| Name | Role | Address |
|---|---|---|
| KALLINI, ADEL | Director | 440 E SAMPLE RD #101, POMPANO BEACH, FL 33064 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 1999-05-07 | KALLINI, ADEL | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1999-05-07 | 440 E SAMPLE RD, #101, POMPANO BCH, FL 33064 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 1999-05-07 |
| ANNUAL REPORT | 1998-05-13 |
| ANNUAL REPORT | 1997-05-05 |
| ANNUAL REPORT | 1996-08-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
