0001625536-14-000001.txt : 20141117 0001625536-14-000001.hdr.sgml : 20141117 20141117112626 ACCESSION NUMBER: 0001625536-14-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20141117 DATE AS OF CHANGE: 20141117 EFFECTIVENESS DATE: 20141117 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Tampa Minimally Invasive Spine Surgery Center, LLC CENTRAL INDEX KEY: 0001625536 IRS NUMBER: 471211888 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-228454 FILM NUMBER: 141226826 BUSINESS ADDRESS: STREET 1: 5329 PRIMROSE LAKE CIRCLE CITY: TAMPA STATE: FL ZIP: 33647 BUSINESS PHONE: 813-875-0562 MAIL ADDRESS: STREET 1: 5329 PRIMROSE LAKE CIRCLE CITY: TAMPA STATE: FL ZIP: 33647 D 1 primary_doc.xml X0707 D LIVE 0001625536 Tampa Minimally Invasive Spine Surgery Center, LLC 5329 PRIMROSE LAKE CIRCLE TAMPA FL FLORIDA 33647 813-875-0562 DELAWARE None None Limited Liability Company true 2013 Philip Henkin, M.D. 5329 Primrose Lake Circle Tampa FL FLORIDA 33647 Executive Officer Director Manager Willem Nel, M.D. 5329 Primrose Lake Circle Tampa FL FLORIDA 33647 Executive Officer Director Manager Dario Grisales, M.D. 5329 Primrose Lake Circle Tampa FL FLORIDA 33647 Executive Officer Director Manager Devanand Mangar, M.D. 5329 Primrose Lake Circle Tampa FL FLORIDA 33647 Executive Officer Director Manager Jay Rom 5329 Primrose Lake Circle Tampa FL FLORIDA 33647 Executive Officer Director Manager Hospitals and Physicians Decline to Disclose 06b false 2014-11-01 false true false 7000 700000 700000 0 false 5 0 0 0 false Tampa Minimally Invasive Spine Surgery Center, LLC /s/ Jay Rom Jay Rom Manager 2014-11-14