| Entity Name: | LAKE CITY SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Aug 2007 (17 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 Jun 2011 (14 years ago) |
| Document Number: | L07000088906 |
| FEI/EIN Number | 260811545 |
| Address: | 208 SW PROSPERITY PLACE, LAKE CITY, FL, 32024, US |
| Mail Address: | 208 SW PROSPERITY PLACE, LAKE CITY, FL, 32024, US |
| ZIP code: | 32024 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598965634 | 2007-07-18 | 2017-03-31 | 208 SW PROSPERITY PLACE, LAKE CITY, FL, 32024, US | 208 SW PROSPERITY PLACE, LAKE CITY, FL, 32024, US | |||||||||||||||||||||||||
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| Phone | +1 386-487-3930 |
| Fax | 3864873935 |
Authorized person
| Name | DERENDA TIMBERLAKE |
| Role | ADMINISTRATOR |
| Phone | 3864873930 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1046 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | ASC MEDICARE IDENTIFICATI |
| Number | 10-C0001276 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THANAWALA RIZWANA | Agent | 4367 NW AMERICAN LANE, LAKE CITY, FL, 32055 |
| Name | Role | Address |
|---|---|---|
| Thanawala RIZWANA Dr. | Managing Member | 6614 nw 50th lane, gainesville, FL, 32653 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-13 | 208 SW PROSPERITY PLACE, LAKE CITY, FL 32024 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-13 | 208 SW PROSPERITY PLACE, LAKE CITY, FL 32024 | No data |
| LC AMENDMENT | 2011-06-21 | No data | RECEIVED COURT ORDER LAYING ASIDE D ISSOLUTION - SEE IMAGE |
| REGISTERED AGENT ADDRESS CHANGED | 2010-04-05 | 4367 NW AMERICAN LANE, LAKE CITY, FL 32055 | No data |
| LC VOLUNTARY DISSOLUTION | 2010-04-05 | No data | No data |
| LC AMENDMENT | 2009-03-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-16 | THANAWALA, RIZWANA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-13 |
| ANNUAL REPORT | 2023-04-01 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-05-24 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-01-13 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
