| Entity Name: | SPACE COAST SURGICAL CENTER, LTD. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Partnership |
| Status: | Active |
| Date Filed: | 30 Dec 1993 (31 years ago) |
| Last Event: | LP AMENDMENT |
| Event Date Filed: | 14 Feb 2018 (7 years ago) |
| Document Number: | A93000001462 |
| FEI/EIN Number | 75-2516426 |
| Address: | 220 North Sykes Creek Parkway, Suite 101, Merrit Island, FL 32953 |
| Mail Address: | 220 North Sykes Creek Parkway, Suite 101, Merrit Island, FL 32953 |
| ZIP code: | 32953 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437112455 | 2006-04-10 | 2016-03-28 | 220 N SYKES CREEK PKWY, SUITE 101, MERRITT ISLAND, FL, 329533490, US | 220 N SYKES CREEK PKWY, SUITE 101, MERRITT ISLAND, FL, 329533490, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 321-459-0015 |
| Fax | 3214592291 |
Authorized person
| Name | CYNTHIA A JOHNSON |
| Role | ADMINISTRATOR |
| Phone | 3214590015 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 984 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 079154700 |
| State | FL |
| CIK number | Mailing Address | Business Address | Phone | |
|---|---|---|---|---|
| 1678554 | 220 N. SYKES CREEK PARKWAY, MERRITT ISLAND, FL, 32953 | 220 N. SYKES CREEK PARKWAY, MERRITT ISLAND, FL, 32953 | 321-459-0015 | |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G00179900336 | MERRITT ISLAND SURGERY CENTER | ACTIVE | 2000-06-27 | 2025-12-31 | No data | 220 N SYKES CREEK PARKWAY, SUITE 101, MERRITT ISLAND, FL, 32953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-03 | 220 North Sykes Creek Parkway, Suite 101, Merrit Island, FL 32953 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-03 | 220 North Sykes Creek Parkway, Suite 101, Merrit Island, FL 32953 | No data |
| LP AMENDMENT | 2018-02-14 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-04-26 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2002-01-26 | CT CORPORATION SYSTEM | No data |
| NAME CHANGE AMENDMENT | 1994-02-10 | SPACE COAST SURGICAL CENTER, LTD. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-06-03 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-04-26 |
| LP Amendment | 2018-02-14 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
