| Entity Name: | PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 May 2003 (22 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 16 Sep 2016 (8 years ago) |
| Document Number: | L03000016970 |
| FEI/EIN Number | 04-3757244 |
| Address: | 15821 HOLLYFERN CT, FT MYERS, FL 33908 |
| Mail Address: | 15880 SUMMERLIN ROAD #300, PMB #322, FT MYERS, FL 33908 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386786838 | 2007-02-13 | 2020-08-22 | 15880 SUMMERLIN RD, STE 300 PMB 322, FORT MYERS, FL, 339089612, US | 15821 HOLLYFERN COURT, FORT MYERS, FL, 33908, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-432-5100 |
| Fax | 2394325135 |
Authorized person
| Name | ANNETTE L MURRAY |
| Role | PRACTICE MANAGER |
| Phone | 2394325100 |
Taxonomy
| Taxonomy Code | 207XP3100X - Pediatric Orthopaedic Surgery Physician |
| License Number | OS4993 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DR. JOHN CHURCHILL NPI |
| Number | 1245244995 |
| State | FL |
| Issuer | DR. DENNIS CARDONE NPI |
| Number | 1043224520 |
| State | FL |
| Issuer | DR. F. BRETT SHANNON NPI |
| Number | 1518971225 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KNOTT, GEORGE HESQ | Agent | KNOTT, EBELINI, HART PA, 1625 HENDRY ST, STE 301, FT MYERS, FL 33901 |
| Name | Role | Address |
|---|---|---|
| Cola, Kristin M, Dr. | President | 15880 SUMMERLIN ROAD, #300 PMB #322 FT MYERS, FL 33908 |
| Name | Role | Address |
|---|---|---|
| Harlow, Amy J, Dr. | Vice President | 15880 SUMMERLIN ROAD, #300 PMB #322 FT MYERS, FL 33908 |
| Name | Role | Address |
|---|---|---|
| F. BRETT SHANNON, DO | Secretary | 15880 SUMMERLIN RD #300, PMB #322, FT MYERS, FL 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2016-09-16 | PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA, PLLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-03-06 | KNOTT, EBELINI, HART PA, 1625 HENDRY ST, STE 301, FT MYERS, FL 33901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-02-27 | 15821 HOLLYFERN CT, FT MYERS, FL 33908 | No data |
| CHANGE OF MAILING ADDRESS | 2006-02-27 | 15821 HOLLYFERN CT, FT MYERS, FL 33908 | No data |
| NAME CHANGE AMENDMENT | 2003-10-20 | PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA, L.L.C. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-03-14 |
| AMENDED ANNUAL REPORT | 2021-11-05 |
| ANNUAL REPORT | 2021-01-23 |
| AMENDED ANNUAL REPORT | 2020-10-30 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-02-02 |
| ANNUAL REPORT | 2017-01-29 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
