| Entity Name: | COASTAL SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Oct 2004 (20 years ago) |
| Document Number: | L04000077462 |
| FEI/EIN Number | 202667835 |
| Address: | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL, 32216 |
| Mail Address: | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL, 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902832405 | 2006-06-25 | 2020-08-22 | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL, 322160996, US | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL, 322160996, US | |||||||||||||||||||||||||
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| Phone | +1 904-332-6774 |
| Fax | 9043329137 |
Authorized person
| Name | SANDRA A HARMS |
| Role | ADMINISTRATOR |
| Phone | 9043326774 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 14960580 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 6N6 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FEE TIMOTHY E | Agent | 4147 SOUTHPOINT DRIVE EAST, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| FEE TIMOTHY E | Manager | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-01-13 | FEE, TIMOTHY E, dr | No data |
| REGISTERED AGENT NAME CHANGED | 2008-03-27 | FEE, TIMOTHY EM.D. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-03-27 | 4147 SOUTHPOINT DRIVE EAST, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-03 | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 2006-01-03 | 4147 SOUTHPOINT DR E, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-16 |
| ANNUAL REPORT | 2021-01-10 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-07-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
