| Entity Name: | FLORIDA LAKES SURGICAL, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 May 2007 (18 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 29 Sep 2009 (15 years ago) |
| Document Number: | L07000049156 |
| FEI/EIN Number | 208995750 |
| Address: | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870, US |
| Mail Address: | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870, US |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174727937 | 2007-06-13 | 2015-05-11 | 4751 LAKEVIEW DR, SEBRING, FL, 338702064, US | 4751 LAKEVIEW DR, SEBRING, FL, 338702064, US | |||||||||||||||||||||
|
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| Phone | +1 863-402-5600 |
| Fax | 8634025602 |
Authorized person
| Name | DR. THOMAS C LACKEY II |
| Role | OWNER |
| Phone | 86340265600 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 279537000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LACKEY THOMAS C | Agent | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Name | Role | Address |
|---|---|---|
| LACKEY THOMAS CII | Manager | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000001735 | YOUR HEALTH | ACTIVE | 2015-01-06 | 2025-12-31 | No data | 4751 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-03-27 | 4759 LAKEVIEW DRIVE, SEBRING, FL 33870 | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-27 | 4759 LAKEVIEW DRIVE, SEBRING, FL 33870 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-27 | 4759 LAKEVIEW DRIVE, SEBRING, FL 33870 | No data |
| CANCEL ADM DISS/REV | 2009-09-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2008-01-14 | LACKEY, THOMAS CII | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-07-01 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-06-27 |
| ANNUAL REPORT | 2017-03-27 |
| ANNUAL REPORT | 2016-03-26 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
