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  5. SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC

SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC

Company Details

Entity Name: SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 17 May 2004 (21 years ago)
Date of dissolution: 28 Sep 2018 (6 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2018 (6 years ago)
Document Number: L04000037106
FEI/EIN Number 201163763
Address: 2460 OLD MOULTRIE ROAD, SUITE 3, ST. AUGUSTINE, FL, 32086
Mail Address: P.O. BOX 3127, ST. AUGUSTINE, FL, 32085-3127
ZIP code: 32086
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1417054826 2006-09-20 2020-08-22 P O BOX 3127, ST AUGUSTINE, FL, 320853127, US 2460 OLD MOULTRIE ROAD, SUITE 2, ST AUGUSTINE, FL, 320864198, US

Contacts
Phone +1 904-797-6627
Fax 9047976028

Authorized person
Name GEORGE EDWARD SADOWSKI
Role DIRECTOR
Phone 9047976627

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
License Number ME54115
State FL
Is Primary Yes
Taxonomy Code 208600000X - Surgery Physician
License Number ME87867
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 269607000
State FL
Issuer MEDICAID
Number 062191900
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2012 201163763 2013-10-15 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE RD., ST. AUGUSTINE, FL, 320853127

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing DR. GEORGE SADOWSKI
Valid signature Filed with authorized/valid electronic signature
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2011 201163763 2012-10-09 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127

Plan administrator’s name and address
Administrator’s EIN 201163763
Plan administrator’s name SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Plan administrator’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127
Administrator’s telephone number 9047976522

Signature of
Role Plan administrator
Date 2012-10-09
Name of individual signing GEORGE SADOWSKI MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-09
Name of individual signing GEORGE SADOWSKI MD
Valid signature Filed with authorized/valid electronic signature
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2010 201163763 2011-10-20 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127

Plan administrator’s name and address
Administrator’s EIN 201163763
Plan administrator’s name SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Plan administrator’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127
Administrator’s telephone number 9047976522

Signature of
Role Plan administrator
Date 2011-10-20
Name of individual signing GEORGE SADOWSKI
Valid signature Filed with authorized/valid electronic signature
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2010 201163763 2011-10-10 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 8
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127

Plan administrator’s name and address
Administrator’s EIN 201163763
Plan administrator’s name SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Plan administrator’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127
Administrator’s telephone number 9047976522

Signature of
Role Plan administrator
Date 2011-10-10
Name of individual signing GEORGE SADOWSKI
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-10-10
Name of individual signing GEORGE SADOWSKI
Valid signature Filed with incorrect/unrecognized electronic signature
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2010 201163763 2011-10-07 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 8
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127

Plan administrator’s name and address
Administrator’s EIN 201163763
Plan administrator’s name SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Plan administrator’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127
Administrator’s telephone number 9047976522
SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC PENSION PLAN AND TRUST 2009 201163763 2010-10-20 SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 9047976522
Plan sponsor’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127

Plan administrator’s name and address
Administrator’s EIN 201163763
Plan administrator’s name SURGICAL ASSOCIATES OF NORTH FLORIDA, LLC
Plan administrator’s address 2460 OLD MOULTRIE ROAD, ST. AUGUSTINE, FL, 320853127
Administrator’s telephone number 9047976522

Signature of
Role Plan administrator
Date 2010-10-20
Name of individual signing GEORGE SADOWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-20
Name of individual signing GEORGE SADOWSKI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SADOWSKI GEORGE E Agent 2460 OLD MOULTRIE RD, SAINT AUGUSTINE, FL, 32086

President

Name Role Address
SADOWSKI GEORGE President POB 3127, SAINT AUGUSTINE, FL, 32085

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data
REGISTERED AGENT NAME CHANGED 2005-02-04 SADOWSKI, GEORGE E No data
REGISTERED AGENT ADDRESS CHANGED 2005-02-04 2460 OLD MOULTRIE RD, SUITE 3, SAINT AUGUSTINE, FL 32086 No data

Documents

Name Date
ANNUAL REPORT 2017-03-03
ANNUAL REPORT 2016-02-16
ANNUAL REPORT 2015-03-09
ANNUAL REPORT 2014-02-18
ANNUAL REPORT 2013-02-28
ANNUAL REPORT 2012-02-07
ANNUAL REPORT 2011-03-08
ANNUAL REPORT 2010-03-23
ANNUAL REPORT 2009-04-28
ANNUAL REPORT 2008-04-21

Related by officers

SADOWSKI GEORGE

NB NATURAL, LLC GOLDLEAF GENERAL PARTNERS I, LLC LINBERG, INC. IMPRESSIVE REHAB LLC MOULTRIE MEDICAL PLAZA FAMILY PARTNERSHIP, LTD.

SADOWSKI GEORGE E

VISABLE INVESTMENTS LLC MOULTRIE MEDICAL IMPROVEMENT LLC LINBERG II, INC. NB SKIN INSTITUTE, INC. MAX R.O.I., LLC GOLDLEAF RE DEVELOPMENT, LLC LINBERG PROPERTIES FAMILY LIMITED PARTNERSHIP GEORGE E. SADOWSKI, M.D., P.A.

Related by address

2460 OLD MOULTRIE ROAD, SUITE 3, ST. AUGUSTINE, FL, 32086

GEORGE E. SADOWSKI, M.D., P.A.

P.O. BOX 3127, ST. AUGUSTINE, FL, 32085-3127

GEORGE E. SADOWSKI, M.D., P.A.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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