| Entity Name: | PEDIATRIC SURGERY CENTER - ODESSA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Apr 2006 (19 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 17 Sep 2018 (6 years ago) |
| Document Number: | L06000043456 |
| FEI/EIN Number | 651274446 |
| Mail Address: | 14201 Dallas Parkway, Dallas, TX, 75254, US |
| Address: | 14111 STATE RD 54, ODESSA, FL, 75001, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750565594 | 2007-12-27 | 2024-09-17 | 14111 STATE ROAD 54, ODESSA, FL, 335563663, US | 14111 STATE ROAD 54, ODESSA, FL, 335563663, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 813-343-5690 |
| Fax | 8137921845 |
Authorized person
| Name | COLLIN LEMAISTRE |
| Role | AUTHORIZED OFFICIAL |
| Phone | 2142130732 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000348000 |
| State | FL |
| Issuer | MEDICAID |
| Number | 007254600 |
| State | FL |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300ONDLYJW68XYG50 | L06000043456 | US-FL | GENERAL | ACTIVE | No data | |||||||||||||||||||
|
||||||||||||||||||||||||
| Legal | C/O C T Corporation System, 1200 South Pine Island Road, Plantation, US-FL, US, 33324 |
| Headquarters | C/O C T Corporation System, 1200 South Pine Island Road, Plantation, US-FL, US, 33324 |
Registration details
| Registration Date | 2013-03-25 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2014-03-25 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | L06000043456 |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Bowden James | Secretary | 14201 Dallas Parkway, Dallas, TX, 75254 |
| Name | Role | Address |
|---|---|---|
| Sims Karen | Auth | 14201 DALLAS PKWY, Dallas, TX, 75254 |
| Name | Role |
|---|---|
| NATIONAL SURGERY CENTER HOLDINGS, INC. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-06-20 | 14111 STATE RD 54, ODESSA, FL 75001 | No data |
| LC AMENDMENT | 2018-09-17 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-09-17 | 14111 STATE RD 54, ODESSA, FL 75001 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-12-06 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-12-06 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-02 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-02-10 |
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-06-20 |
| ANNUAL REPORT | 2019-05-01 |
| LC Amendment | 2018-09-17 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-04-17 |
| ANNUAL REPORT | 2016-04-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
