| Entity Name: | EXTENDCARE PHYSICIAN SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 11 Feb 2008 (17 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L08000014842 |
| FEI/EIN Number | 261972563 |
| Address: | 154 LOOKOUT POINT DRIVE, OSPREY, FL, 34229 |
| Mail Address: | 154 LOOKOUT POINT DRIVE, OSPREY, FL, 34229 |
| ZIP code: | 34229 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831360593 | 2008-03-20 | 2008-11-24 | PO BOX 511805, PUNTA GORDA, FL, 339511805, US | 700 MEDICAL BLVD, ENGLEWOOD, FL, 342233964, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 941-923-5861 |
Authorized person
| Name | DR. CLAUDE J MASON |
| Role | PHYSICIAN |
| Phone | 9419235861 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| License Number | ME79271 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000287700 |
| State | FL |
| Issuer | RAILROAD MEDICARE PTAN |
| Number | DN3536 |
| State | FL |
| Issuer | BCBS |
| Number | 33085 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COOPER FRANCES GRACE E | Agent | 154 LOOKOUT POINT DRIVE, SARASOTA, FL, 34229 |
| Name | Role | Address |
|---|---|---|
| MASON C. JOHN M | Managing Member | 154 LOOKOUT POINT DRIVE, OSPREY, FL, 34229 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08102700078 | INPATIENT MEDICAL SPECIALISTS | EXPIRED | 2008-04-11 | 2013-12-31 | No data | 154 LOOKOUT POINT DRIVE, OSPREY, FL, 34229 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-16 | 154 LOOKOUT POINT DRIVE, SARASOTA, FL 34229 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J15000966461 | INACTIVE WITH A SECOND NOTICE FILED | 2015 CA 003313 NC | 12TH JUD CIR. SARASOTA CO. | 2015-10-14 | 2020-11-02 | $80,424.63 | ENGLEWOOD COMMUNITY HOSPITAL, INC. D/B/A, ENGLEWOOD COMMUNITY HOSPITAL, 700 MEDICAL BLVD, ENGLEWOOD, FLORIDA 34223 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-27 |
| ANNUAL REPORT | 2011-02-16 |
| ANNUAL REPORT | 2010-01-05 |
| ANNUAL REPORT | 2009-01-23 |
| Florida Limited Liability | 2008-02-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
