| Entity Name: | KEY WEST SURGICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Aug 1982 (43 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 20 Jun 2024 (8 months ago) |
| Document Number: | F91934 |
| FEI/EIN Number | 59-2206188 |
| Address: | C/O JUAN M. LARRAURI, 3136 NORTHSIDE DR., KEY WEST, FL 33040 |
| Mail Address: | C/O JUAN M. LARRAURI, 3136 NORTHSIDE DR., KEY WEST, FL 33040 |
| ZIP code: | 33040 |
| County: | Monroe |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215039409 | 2006-09-01 | 2022-07-21 | 3136 NORHTSIDE DRIVE, KEY WEST, FL, 330408027, US | 3136 NORHTSIDE DRIVE, KEY WEST, FL, 330408027, US | |||||||||||||||||||||||
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| Phone | +1 305-294-1041 |
| Fax | 3052930990 |
Authorized person
| Name | ANA C SEGURA-GARCIA |
| Role | BILLING-CODING |
| Phone | 3052941041 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255847500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Smith, Rhoda M, MD | Agent | 3136 Northside Drive, Key West, FL 33040 |
| Name | Role | Address |
|---|---|---|
| LARRAURI, JUAN M, M.D. | Vice President | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| Name | Role | Address |
|---|---|---|
| LARRAURI, JUAN M, M.D. | Treasurer | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| Name | Role | Address |
|---|---|---|
| LARRAURI, JUAN M, M.D. | Secretary | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| Name | Role | Address |
|---|---|---|
| LARRAURI, JUAN M, M.D. | Director | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| SMITH, RHODA M | Director | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| Name | Role | Address |
|---|---|---|
| SMITH, RHODA M | President | 3136 NORTHSIDE DRIVE, KEY WEST, FL 33040 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2024-06-20 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-01-12 | Smith, Rhoda M, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-20 | 3136 Northside Drive, Key West, FL 33040 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-24 | C/O JUAN M. LARRAURI, 3136 NORTHSIDE DR., KEY WEST, FL 33040 | No data |
| AMENDMENT AND NAME CHANGE | 2016-04-07 | KEY WEST SURGICAL GROUP, INC. | No data |
| CHANGE OF MAILING ADDRESS | 2011-10-12 | C/O JUAN M. LARRAURI, 3136 NORTHSIDE DR., KEY WEST, FL 33040 | No data |
| REINSTATEMENT | 2011-10-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| NAME CHANGE AMENDMENT | 2004-06-15 | LARRAURI, KLITENICK AND SMITH, M.D., P.A. | No data |
| NAME CHANGE AMENDMENT | 2003-11-12 | LARRAURI AND KLITENICK, M.D., P.A. | No data |
| Name | Date |
|---|---|
| Amendment | 2024-06-20 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-25 |
| AMENDED ANNUAL REPORT | 2022-05-17 |
| ANNUAL REPORT | 2022-01-12 |
| ANNUAL REPORT | 2021-01-20 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-04-04 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
