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  5. FLORIDA AMBULATORY ANESTHESIA, LLC

FLORIDA AMBULATORY ANESTHESIA, LLC

Company Details

Entity Name: FLORIDA AMBULATORY ANESTHESIA, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 02 Apr 2004 (21 years ago)
Date of dissolution: 28 Sep 2012 (12 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2012 (12 years ago)
Document Number: L04000025159
FEI/EIN Number 061721757
Mail Address: 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Address: 1395 STATE ROAD 7, SUITE 100, WELLINGTON, FL, 33414
ZIP code: 33414
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275640328 2006-08-24 2010-05-14 PO BOX 9117, UNIONDALE, NY, 115559117, US 1395 STATE ROAD 7, SUITE 100, WELLINGTON, FL, 334149326, US

Contacts
Phone +1 800-910-9207
Phone +1 561-422-1950
Fax 5614220997

Authorized person
Name RONALD N SMITH
Role MANAGING DIRECTOR
Phone 5614221950

Taxonomy
Taxonomy Code 207L00000X - Anesthesiology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 271682800
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FLORIDA AMBULATORY ANESTHESIA, LLC DEFINED BENEFIT PLAN 2011 061721757 2012-10-11 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
FLORIDA AMBULATORY ANESTHESIA, LLC 401(K) PLAN 2011 061721757 2012-10-11 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
FLORIDA AMBULATORY ANESTHESIA, LLC 401(K) PLAN 2010 061721757 2011-10-05 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-05
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
FLORIDA AMBULATORY ANESTHESIA, LLC DEFINED BENEFIT PLAN 2010 061721757 2011-10-05 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-05
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
FLORIDA AMBULATORY ANESTHESIA, LLC 401(K) PLAN 2009 061721757 2010-10-01 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2010-10-01
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-01
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
FLORIDA AMBULATORY ANESTHESIA, LLC DEFINED BENEFIT PLAN 2009 061721757 2010-09-22 FLORIDA AMBULATORY ANESTHESIA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 5614220994
Plan sponsor’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 061721757
Plan administrator’s name FLORIDA AMBULATORY ANESTHESIA, LLC
Plan administrator’s address 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
Administrator’s telephone number 5614220994

Signature of
Role Plan administrator
Date 2010-09-21
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-21
Name of individual signing RONALD SMITH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SMITH RONALD N Agent 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

Managing Member

Name Role Address
SMITH RONALD N Managing Member 15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414
BHARDWAJ NISHA M Managing Member 11104 GREEN BAYBERRY DRIVE, PALM BEACH GARDENS, FL, 33418

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2012-09-28 No data No data
CHANGE OF PRINCIPAL ADDRESS 2005-02-14 1395 STATE ROAD 7, SUITE 100, WELLINGTON, FL 33414 No data
REGISTERED AGENT NAME CHANGED 2005-02-14 SMITH, RONALD N No data
REGISTERED AGENT ADDRESS CHANGED 2005-02-14 15761 CEDAR GROVE LANE, WELLINGTON, FL 33414 No data
AMENDMENT 2004-12-21 No data No data

Documents

Name Date
ANNUAL REPORT 2011-04-04
ANNUAL REPORT 2010-01-21
ANNUAL REPORT 2009-02-09
ANNUAL REPORT 2008-01-21
ANNUAL REPORT 2007-01-25
ANNUAL REPORT 2006-02-25
ANNUAL REPORT 2005-02-14
Amendment 2004-12-21
Florida Limited Liabilites 2004-04-02

Related by officers

SMITH RONALD N

BIG RONZ MOBILE REPAIR LLC RONALD N. SMITH, M.D., P.A. DEPARTMENT OF HEALTHCARE PRACTICE MANAGEMENT, LLC

BHARDWAJ NISHA M

NISHA BHARDWAJ MD PA

Related by address

15761 CEDAR GROVE LANE, WELLINGTON, FL, 33414

TAMMY HEATHER SMITH, LLC TTT SUPPORT LLC RONALD N. SMITH, M.D., P.A.

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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