| Entity Name: | LIVE OAK ENDOSCOPY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Jun 2002 (23 years ago) |
| Document Number: | L02000013758 |
| FEI/EIN Number | 01-0709517 |
| Address: | 275 18TH STREET, SUITE 101, VERO BEACH, FL 32960-5541 |
| Mail Address: | 275 18 STREET SUITE 101, 101, VERO BEACH, FL 32960 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548254402 | 2005-09-07 | 2009-06-08 | 275 18TH ST, SUITE 101, VERO BEACH, FL, 329605555, US | 275 18TH ST, SUITE 101, VERO BEACH, FL, 329605555, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-299-5005 |
| Fax | 7722991340 |
Authorized person
| Name | MR. WILLIAM J MCCORMACK |
| Role | C.E.O. |
| Phone | 7722995005 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1154 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075390400 |
| State | FL |
| Issuer | BC BS FLORIDA |
| Number | 6B6 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 490005670 |
| State | FL |
| Issuer | CIGNA |
| Number | 4677223 |
| Issuer | OXFORD HEALTH PLAN |
| Number | A2882678 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LIVE OAK ENDOSCOPY CENTER 401(K) PLAN | 2023 | 010709517 | 2024-05-07 | LIVE OAK ENDOSCOPY CENTER | 18 | |||||||||||||
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| LIVE OAK ENDOSCOPY CENTER 401(K) PLAN | 2022 | 010709517 | 2023-05-31 | LIVE OAK ENDOSCOPY CENTER | 0 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| JOSEPH, PRAMOD | Agent | 275 18TH STREET, SUITE 101, VERO BEACH, FL 32960-5541 |
| Name | Role | Address |
|---|---|---|
| SOUTH FLORIDA MEDICAL ASSOCIATES LLC | Authorized Member | No data |
| JOSEPH, PRAMOD, MD | Authorized Member | 12350 NW 39TH STREET, SUITE 200 CORAL SPRINGS, FL 33065 |
| ALLEN, LICHT | Authorized Member | 12350 NW 39TH STREET, SUITE 200 CORAL SPRINGS, FL 33065 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G02347900223 | LIVE OAK ENDOSCOPY CENTER | ACTIVE | 2002-12-13 | 2027-12-31 | No data | 275 18TH STREET, SUITE 101, VERO BEACH, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-30 | 275 18TH STREET, SUITE 101, VERO BEACH, FL 32960-5541 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-30 | JOSEPH, PRAMOD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 275 18TH STREET, SUITE 101, VERO BEACH, FL 32960-5541 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-01-26 | 275 18TH STREET, SUITE 101, VERO BEACH, FL 32960-5541 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-01-25 |
| AMENDED ANNUAL REPORT | 2022-06-26 |
| AMENDED ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-09 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
