| Entity Name: | BRANDON AMBULATORY SURGERY CENTER, LC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 Feb 2004 (21 years ago) |
| Date of dissolution: | 18 Dec 2023 (a year ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 18 Dec 2023 (a year ago) |
| Document Number: | L04000015663 |
| FEI/EIN Number | 20-2387834 |
| Address: | 514 Eichenfeld Drive, Brandon, FL, 33511, US |
| Mail Address: | 514 Eichenfeld Drive, Brandon, FL, 33511, US |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710071519 | 2006-10-03 | 2019-09-17 | 514 EICHENFELD DRIVE, BRANDON, FL, 33511, US | 514 EICHENFELD DRIVE, BRANDON, FL, 33511, US | |||||||||||||||||||||
|
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| Phone | +1 813-571-7088 |
| Fax | 8135717099 |
Authorized person
| Name | PAULA RUSSO |
| Role | CHIEF ADMINISTRATIVE OFFICER |
| Phone | 8135717088 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 076908800 |
| State | FL |
| CIK number | Mailing Address | Business Address | Phone | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1745139 | 514 EICHENFELD DRIVE, BRANDON, FL, 33511 | 514 EICHENFELD DRIVE, BRANDON, FL, 33511 | 813-571-7088 | |||||||||
|
||||||||||||
| Form type | D |
| File number | 021-316077 |
| Filing date | 2018-07-05 |
| File | View File |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| SCA-Brandon, LLC | Member | 514 Eichenfeld Drive, Brandon, FL, 33511 |
| SC Affiliates, LLC | Member | 514 Eichenfeld Drive, Brandon, FL, 33511 |
| Endoscopy Center Affiliates, Inc. | Member | 514 Eichenfeld Drive, Brandon, FL, 33511 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000087902 | EAST HILLSBOROUGH SURGERY CENTER | ACTIVE | 2018-08-08 | 2028-12-31 | No data | 514 EICHENFELD DRIVE, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2023-12-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-24 | 514 Eichenfeld Drive, Brandon, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-24 | 514 Eichenfeld Drive, Brandon, FL 33511 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-25 | 1200 South Pine Island Road, Plantation, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-25 | C T Corporation System | No data |
| LC AMENDED AND RESTATED ARTICLES | 2008-02-29 | No data | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2005-02-21 | BRANDON AMBULATORY SURGERY CENTER, LC | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J15000964300 | TERMINATED | 15-CA-003144 | HILLSBOROUGH COUNTY | 2015-09-03 | 2020-10-28 | $70,830.07 | LIONS EYE INSTITUTE FOR TRANSPLANT AND RESEARCH, INC., 1410 NORTH 21ST ST., TAMPA, FL 33605 |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2023-12-18 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-05-31 |
| ANNUAL REPORT | 2019-03-19 |
| AMENDED ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-02-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
