| Entity Name: | PALM BEACH SURGERY CENTER, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 28 Oct 2002 (22 years ago) |
| Date of dissolution: | 06 Jan 2016 (9 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Jan 2016 (9 years ago) |
| Document Number: | L02000028573 |
| FEI/EIN Number | 611431700 |
| Address: | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL, 33414 |
| Mail Address: | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL, 33414 |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972613545 | 2006-08-30 | 2010-10-08 | 1157 S STATE ROAD 7, WELLINGTON, FL, 334146101, US | 1157 S STATE ROAD 7, WELLINGTON, FL, 334146101, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 561-795-3330 |
| Fax | 5617951030 |
Authorized person
| Name | KRISHNA TRIPURANENI |
| Role | OWNER |
| Phone | 5617953330 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1185 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | F1412 |
| State | FL |
| Issuer | BCBS |
| Number | 6E5 |
| State | FL |
| Issuer | MEDICAID |
| Number | 075618100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TRIPURANENI KRISHNA | Agent | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| TRIPURANENI KRISHNA | President | 1157 SOUTH STATE ROAD 7, WEST PALM BEACH, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| TRIPURANENI KRISHNA | Secretary | 1157 SOUTH STATE ROAD 7, WEST PALM BEACH, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| TRIPURANENI KRISHNA | Treasurer | 1157 SOUTH STATE ROAD 7, WEST PALM BEACH, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| TRIPURANENI VENKAT | Vice President | 1157 SOUTH STATE ROAD 7, WEST PALM BEACH, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-06 | No data | No data |
| LC AMENDMENT | 2014-07-03 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-25 | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL 33414 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-01-25 | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2011-01-25 | 1157 SOUTH STATE ROAD 7, WELLINGTON, FL 33414 | No data |
| LC AMENDMENT | 2010-09-13 | No data | No data |
| AMENDMENT | 2004-05-28 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2016-01-06 |
| ANNUAL REPORT | 2015-01-28 |
| LC Amendment | 2014-07-03 |
| ANNUAL REPORT | 2014-01-30 |
| ANNUAL REPORT | 2013-01-22 |
| ANNUAL REPORT | 2012-01-26 |
| ANNUAL REPORT | 2011-01-25 |
| LC Amendment | 2010-09-13 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-01-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
