| Entity Name: | UNIVERSITY PAIN MANAGEMENT CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Jan 1999 (26 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 25 Feb 2016 (9 years ago) |
| Document Number: | P99000006679 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 11707 Club Drive, TAMPA, FL, 33612, US |
| Mail Address: | PO BOX 46518, TAMPA, FL, 33646 |
| ZIP code: | 33612 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730153396 | 2006-02-13 | 2013-12-19 | PO BOX 46518, TAMPA, FL, 336460105, US | 11707 CLUB DR, TAMPA, FL, 336125521, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-977-2222 |
| Fax | 8139774222 |
Authorized person
| Name | SHAUKAT H CHOWDHARI |
| Role | MEDICAL DIRECTOR |
| Phone | 8139772222 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0026925-00 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | DE1204 |
| State | FL |
| Issuer | MEDICAID |
| Number | 0026925-02 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| O'CONNOR PATRICK M | Agent | 1250 SOUTH BELCHER RD, LARGO, FL, 33771 |
| Name | Role | Address |
|---|---|---|
| CHOWDHARI SHAUKAT HMD | President | PO BOX 46518, TAMPA, FL, 33646 |
| Name | Role | Address |
|---|---|---|
| CHOWDHARI SHAUKAT HMD | Director | PO BOX 46518, TAMPA, FL, 33646 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2016-02-25 | UNIVERSITY PAIN MANAGEMENT CENTER, INC. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-14 | 11707 Club Drive, TAMPA, FL 33612 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-18 | 11707 Club Drive, TAMPA, FL 33612 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-08 | 1250 SOUTH BELCHER RD, SUITE 160, LARGO, FL 33771 | No data |
| AMENDMENT AND NAME CHANGE | 2002-06-03 | UNIVERSITY PAIN MANAGEMENT CENTER, P.A. | No data |
| REGISTERED AGENT NAME CHANGED | 2002-04-14 | O'CONNOR, PATRICK MESQ | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-02 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-17 |
| ANNUAL REPORT | 2020-05-11 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-26 |
| Name Change | 2016-02-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
