| Entity Name: | CAPE CORAL AMBULATORY SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Dec 2004 (20 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 27 Jan 2016 (9 years ago) |
| Document Number: | L04000090085 |
| FEI/EIN Number | 202001489 |
| Mail Address: | 340 SEVEN SPRINGS WAY, BRENTWOOD, TX, 37027, US |
| Address: | 2721 Del Prado Blvd, Cape Coral, FL, 33904, US |
| ZIP code: | 33904 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295772101 | 2006-05-31 | 2023-03-01 | 2721 DEL PRADO BLVD S, SUITE 100, CAPE CORAL, FL, 339045781, US | 2721 DEL PRADO BLVD S, SUITE 100, CAPE CORAL, FL, 339045781, US | |||||||||||||||||||||||||
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| Phone | +1 239-242-8010 |
| Fax | 2392428020 |
Authorized person
| Name | JENNIFER BOYD BALDOCK |
| Role | OFFICER AND AUTHORIZED OFFICIAL |
| Phone | 6152345954 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1245 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | 6N1 |
| State | FL |
| CIK number | Mailing Address | Business Address | Phone | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1621611 | 40 BURTON HILLS BLVD., SUITE 500, NASHVILLE, TN, 37215 | 40 BURTON HILLS BLVD., SUITE 500, NASHVILLE, TN, 37215 | 615-234-5900 | |||||||||
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| Form type | D |
| File number | 021-226019 |
| Filing date | 2014-10-08 |
| File | View File |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BALDOCK JENNIFER | Manager | 340 SEVEN SPRINGS WAY, BRENTWOOD, TX, 37027 |
| Name | Role | Address |
|---|---|---|
| O'Brien Jeff | vp | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Name | Role | Address |
|---|---|---|
| Doherty Dave | Vice President | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Kennedy Brett | Vice President | Suite 600 340 Seven Springs Way, Brentwood, TN, 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000136212 | CAPE CORAL SURGERY CENTER | ACTIVE | 2018-12-27 | 2028-12-31 | No data | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN, 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-08 | 2721 Del Prado Blvd, Ste 100, Cape Coral, FL 33904 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-24 | 2721 Del Prado Blvd, Ste 100, Cape Coral, FL 33904 | No data |
| LC STMNT OF RA/RO CHG | 2016-01-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-27 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-27 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-04-24 |
| ANNUAL REPORT | 2016-04-30 |
| CORLCRACHG | 2016-01-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
