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  5. SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA LLC

SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA LLC

Company Details

Entity Name: SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Active
Date Filed: 10 Sep 2008 (16 years ago)
Document Number: L08000086327
FEI/EIN Number 26-3371656
Address: 4519 TILTON COURT, FORT MYERS, FL 33907
Mail Address: 4519 TILTON COURT, FORT MYERS, FL 33907
ZIP code: 33907
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1780835959 2008-10-07 2024-06-04 4519 TILTON CT, FORT MYERS, FL, 339071214, US 4519 TILTON CT, FORT MYERS, FL, 339071214, US

Contacts
Phone +1 239-494-8777
Fax 2392887139

Authorized person
Name DR. THOMAS L BASS
Role PRESIDENT
Phone 2394948777

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
License Number ME66691
State FL
Is Primary Yes

Other Provider Identifiers
Issuer PTAN
Number EU499A
State FL
Issuer MEDICAID
Number 003437100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2023 263371656 2024-07-24 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2022 263371656 2023-04-24 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2021 263371656 2022-05-19 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2020 263371656 2021-05-25 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2019 263371656 2020-05-11 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2018 263371656 2019-05-23 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2017 263371656 2018-07-20 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2018-07-20
Name of individual signing THOMAS BASS, M.D.
Valid signature Filed with authorized/valid electronic signature
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2016 263371656 2017-07-19 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2017-07-19
Name of individual signing THOMAS BASS, M.D.
Valid signature Filed with authorized/valid electronic signature
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2015 263371656 2016-10-03 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2016-10-03
Name of individual signing THOMAS BASS, M.D.
Valid signature Filed with authorized/valid electronic signature
SURGICAL CONSULTANTS OF HOLLYWOOD, P.A. PROFIT SHARING PLAN 2014 263371656 2015-07-07 SURGICAL CONSULTANTS OF SOUTHWEST FLORIDA, LLC 6
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 2394948777
Plan sponsor’s address 4519 TILTON COURT, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2015-07-07
Name of individual signing THOMAS BASS, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BASS, THOMAS Agent 4519 TILTON COURT, FORT MYERS, FL 33907

Managing Member

Name Role Address
BASS, THOMAS Managing Member 4519 TILTON COURT, FORT MYERS, FL 33907

Manager

Name Role Address
Bass, Tiffany Erin Manager 4519 TILTON COURT, FORT MYERS, FL 33907

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09000141293 GULF COAST BARIATRICS EXPIRED 2009-08-03 2014-12-31 No data 1150 N 35TH AVE STE 540, HOLLYWOOD, FL, 33021

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2013-02-13 4519 TILTON COURT, FORT MYERS, FL 33907 No data
REGISTERED AGENT ADDRESS CHANGED 2013-02-13 4519 TILTON COURT, FORT MYERS, FL 33907 No data
CHANGE OF PRINCIPAL ADDRESS 2011-01-10 4519 TILTON COURT, FORT MYERS, FL 33907 No data

Documents

Name Date
ANNUAL REPORT 2024-03-20
ANNUAL REPORT 2023-02-08
ANNUAL REPORT 2022-03-11
ANNUAL REPORT 2021-02-22
ANNUAL REPORT 2020-03-04
ANNUAL REPORT 2019-04-15
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-03-13
ANNUAL REPORT 2016-02-18
ANNUAL REPORT 2015-02-04

Related by officers

BASS, THOMAS

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Related by address

No related companies by address

Date of last update: 26 Jan 2025

Sources: Florida Department of State

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