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  5. PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A.

PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A.

Company Details

Entity Name: PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Aug 1998 (27 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 13 Apr 2001 (24 years ago)
Document Number: P98000068508
FEI/EIN Number 593523458
Address: 1301 PLANTATION ISLAND DR. South, SUITE 301-A, SAINT AUGUSTINE, FL, 32080, US
Mail Address: 1093 A1A BEACH BLVD., SUITE 390, ST.AUGUSTINE, FL, 32080
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1881935567 2013-03-06 2020-09-25 1093 A1A BEACH BLVD, PMB 390, ST AUGUSTINE, FL, 320806733, US 199 S US HIGHWAY 17 STE C, EAST PALATKA, FL, 321316071, US

Contacts
Phone +1 904-460-9555
Fax 9044600090
Phone +1 904-501-3954
Fax 9045013954

Authorized person
Name DR. RAUL A MONZON
Role PRESIDENT
Phone 9044609555

Taxonomy
Taxonomy Code 208VP0014X - Interventional Pain Medicine Physician
License Number ME51281
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 401(K) PLAN 2023 593523458 2024-09-13 PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621498
Sponsor’s telephone number 9045013954
Plan sponsor’s address 1301 PLANTATION ISLAND DR., SUITE 301-A, ST. AUGUSTINE, FL, 32080

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DR., KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2024-09-13
Name of individual signing TARA EVANS, FOR TAG RESOURCES
Valid signature Filed with authorized/valid electronic signature
PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 401(K) PLAN 2022 593523458 2023-06-22 PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621498
Sponsor’s telephone number 9045013954
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, ST. AUGUSTINE, FL, 32080

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DR., KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2023-06-22
Name of individual signing TARA EVANS, FOR TAG RESOURCES
Valid signature Filed with authorized/valid electronic signature
PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 401(K) PLAN 2021 593523458 2022-08-16 PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621498
Sponsor’s telephone number 9045013954
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, ST. AUGUSTINE, FL, 32080

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DR., KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2022-08-16
Name of individual signing TARA EVANS
Valid signature Filed with authorized/valid electronic signature
PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 401(K) PLAN 2020 593523458 2021-05-27 PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621498
Sponsor’s telephone number 9045013954
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, ST. AUGUSTINE, FL, 32080

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DR., KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2021-05-27
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature
PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 401(K) PLAN 2019 593523458 2020-10-06 PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA, P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621498
Sponsor’s telephone number 9044609555
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, ST. AUGUSTINE, FL, 32080

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DR., KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2020-10-06
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MONZON RAUL A Agent 1301 PLANTATION ISLAND DR. South, SAINT AUGUSTINE, FL, 32080

Director

Name Role Address
MONZON RAUL ADr. Director 1301 PLANTATION ISLAND DR.,South, SAINT AUGUSTINE, FL, 32080

President

Name Role Address
MONZON RAUL ADr. President 1301 PLANTATION ISLAND DR.,South, SAINT AUGUSTINE, FL, 32080

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2025-01-10 1301 PLANTATION ISLAND DR. South, SUITE 301-B, SAINT AUGUSTINE, FL 32080 No data
REGISTERED AGENT ADDRESS CHANGED 2025-01-10 1301 PLANTATION ISLAND DR. South, SUITE 301-B, SAINT AUGUSTINE, FL 32080 No data
REINSTATEMENT 2001-04-13 No data No data
CHANGE OF MAILING ADDRESS 2001-04-10 1301 PLANTATION ISLAND DR. South, SUITE 301-B, SAINT AUGUSTINE, FL 32080 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1999-09-24 No data No data

Documents

Name Date
ANNUAL REPORT 2025-01-10
ANNUAL REPORT 2024-01-21
ANNUAL REPORT 2023-01-06
ANNUAL REPORT 2022-01-13
ANNUAL REPORT 2021-01-21
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-03-02

Related by officers

MONZON RAUL A

ACE, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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