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Interventional Pain & Spine Specialists LLC

Company Details

Name: Interventional Pain & Spine Specialists LLC
Legal type: Foreign Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 17 Oct 2019 (6 years ago)
Organization Date: 14 Jun 2018 (7 years ago)
Authority Date: 17 Oct 2019 (6 years ago)
Last Annual Report: 04 Jun 2024 (a year ago)
Organization Number: 1074853
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40241
City: Louisville, Barbourmeade, Broeck Pointe, Brownsboro ...
Primary County: Jefferson County
Principal Office: 4201 SPRINGHURST BLVD, STE 102, LOUISVILLE, KY 40241
Place of Formation: INDIANA

Registered Agent

Name Role
TIMOTHY BEACHAM, MD Registered Agent
Lisa Hastetter Registered Agent

Member

Name Role
Timothy Beacham Member

Authorized Rep

Name Role
Lisa Hastetter Authorized Rep

National Provider Identifier

NPI Number:
1861182198
Certification Date:
2023-05-10

Authorized Person:

Name:
TAMIA FISHER
Role:
AUTHORIZED OFFICIAL
Phone:

Taxonomy:

Selected Taxonomy:
207L00000X - Anesthesiology Physician
Is Primary:
No
Selected Taxonomy:
207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary:
No
Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
No
Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Assumed Names

Name Status Expiration Date
VITALITY PAIN CARE Inactive 2025-03-02

Filings

Name File Date
Annual Report 2024-06-04
Annual Report 2023-03-24
Registered Agent name/address change 2022-12-28
Annual Report 2022-05-18
Registered Agent name/address change 2021-02-12

Sources: Kentucky Secretary of State