| Entity Name: | ENDOSURG OUTPATIENT CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Oct 2000 (24 years ago) |
| Document Number: | L00000013054 |
| FEI/EIN Number | 593678998 |
| Address: | 13838 N US HWY 441/27, LADY LAKE, FL, 32159 |
| Mail Address: | 8110 CR 44 LEG-A, LEESBURG, FL, 34788 |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639105455 | 2006-06-23 | 2014-01-09 | 13838 N US HIGHWAY 441, LADY LAKE, FL, 321598904, US | 13838 N US HIGHWAY 441, LADY LAKE, FL, 321598904, US | |||||||||||||||||||
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| Phone | +1 352-753-1612 |
| Fax | 3527285497 |
Authorized person
| Name | LILY TRAN |
| Role | DOCTOR |
| Phone | 3523238868 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1115 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ISMAIL ISMAIL A | Agent | 8110 CR 44 LEG A, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| TRAN LILY M | Manager | 8110 CR 44 LEG-A, LEESBURG, FL, 34788 |
| ISMAIL ISMAIL ARPH | Manager | 8110 CR 44 LEG A, LEESBURG, FL, 34788 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
