| Entity Name: | GULFSHORE SURGICAL ASSOCIATES, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 11 Jun 2007 (18 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | L07000061266 |
| FEI/EIN Number | 26-0341156 |
| Address: | 8340 COLLIER BLVD, SUITE 203, NAPLES, FL 34110-4 |
| Mail Address: | 8340 COLLIER BLVD, SUITE 203, NAPLES, FL 34110-4 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821289042 | 2007-08-05 | 2008-05-01 | 8340 COLLIER BLVD, SUITE #203, NAPLES, FL, 34114, US | 8340 COLLIER BLVD, SUITE #203, NAPLES, FL, 34114, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 239-774-4275 |
| Fax | 2397744792 |
Authorized person
| Name | DR. ALBERT ANTONIO TITUS |
| Role | OWNER |
| Phone | 2397744275 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME80817 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 35818 |
| State | FL |
| Issuer | MEDICAID |
| Number | 259382300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MINCK, LINDA R, ESQ. | Agent | 5801 PELICAN BAY BLVD., SUITE 300, NAPLES, FL 34108 |
| Name | Role | Address |
|---|---|---|
| TITUS, ALBERT ANTONIO, M.D. | Manager | 9021 MEDINAH COURT, NAPLES, FL 34114 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CANCEL ADM DISS/REV | 2009-05-05 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-05-05 | 8340 COLLIER BLVD, SUITE 203, NAPLES, FL 34110-4 | No data |
| CHANGE OF MAILING ADDRESS | 2009-05-05 | 8340 COLLIER BLVD, SUITE 203, NAPLES, FL 34110-4 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2014-05-23 |
| REINSTATEMENT | 2009-05-05 |
| Florida Limited Liability | 2007-06-11 |
Date of last update: 27 Jan 2025
Sources: Florida Department of State
