| Entity Name: | AESCULAPIAN SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Feb 2002 (23 years ago) |
| Document Number: | L02000004363 |
| FEI/EIN Number | 920179499 |
| Address: | 943 S. BENEVA ROAD, SUITE 306, SARASOTA, FL, 34232 |
| Mail Address: | 943 S. BENEVA ROAD, SUITE 306, SARASOTA, FL, 34232 |
| ZIP code: | 34232 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801869847 | 2006-02-09 | 2016-08-17 | 3333 CATTLEMEN RD, SUITE 100, SARASOTA, FL, 342326056, US | 3333 CATTLEMEN RD, SUITE 100, SARASOTA, FL, 342326056, US | |||||||||||||||||||||||||
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| Phone | +1 941-379-5884 |
| Fax | 9413791760 |
Authorized person
| Name | MR. GEOFFREY G SIMON |
| Role | CEO/ADMINISTRATOR |
| Phone | 9419551108 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1181 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075718700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIMON GEOFFREY G | Agent | 943 S. BENEVA ROAD, STE. 306, SARASOTA, FL, 34232 |
| Name | Role |
|---|---|
| INTERCOASTAL MEDICAL GROUP, INC. | Managing Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000135527 | INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CENTER | EXPIRED | 2009-07-16 | 2024-12-31 | No data | 943 S BENEVA RD, SUITE 306, SARASOTA, FL, 34232 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
