| Entity Name: | LARGO SURGERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Dec 2001 (23 years ago) |
| Document Number: | L01000021601 |
| FEI/EIN Number | 010553657 |
| Mail Address: | 340 SEVEN SPRINGS WAY, BRENTWOOD, TN, 37027, US |
| Address: | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831195379 | 2005-06-21 | 2023-06-26 | 1401 W BAY DR, LARGO, FL, 337702207, US | 1401 W BAY DR, LARGO, FL, 337702207, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 727-585-9500 |
| Fax | 7275841938 |
Authorized person
| Name | JENNIFER BOYD BALDOCK |
| Role | OFFICER AND AUTHORIZED |
| Phone | 6152345954 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 781 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 800005342 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 070644200 |
| State | FL |
| Issuer | CIGNA |
| Number | 0771519008 |
| Issuer | BLUE CROSS/BLUE SHIELD |
| Number | 691 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BALDOCK JENNIFER | Manager | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| O'Brien Jeff | vp | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Doherty Dave | vp | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Kennedy Brett | vp | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08240900256 | WEST BAY SURGERY CENTER | ACTIVE | 2008-08-27 | 2028-12-31 | No data | 310 SEVEN SPRINGS WAY, STE 500, BRENTWOOD, TN, 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2016-01-27 | No data | No data |
| REINSTATEMENT | 2008-06-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| REINSTATEMENT | 2005-03-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
