| Entity Name: | LEESBURG REGIONAL MEDICAL CENTER PHYSICIAN SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 31 Dec 2008 (16 years ago) |
| Document Number: | L09000000525 |
| FEI/EIN Number | 26-3978727 |
| Address: | 600 EAST DIXIE AVENUE, LEESBURG, FL 34748 |
| Mail Address: | 600 EAST DIXIE AVENUE, LEESBURG, FL 34748 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104063114 | 2009-01-13 | 2024-02-22 | 600 E DIXIE AVE, LEESBURG, FL, 347485925, US | 600 E DIXIE AVE, LEESBURG, FL, 347485925, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-323-5002 |
| Fax | 3523235039 |
| Phone | +1 352-323-5979 |
Authorized person
| Name | MRS. HEATHER LONG |
| Role | PRESIDENT, CEO |
| Phone | 3523234271 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME102387 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME101492 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME062340 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| BRAUN, PHILIP J | Agent | 715 WEST OAK TERRACE DR, LEESBURG, FL 34748 |
| Name | Role |
|---|---|
| LEESBURG REGIONAL MEDICAL CENTER, INC. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-31 | 715 WEST OAK TERRACE DR, LEESBURG, FL 34748 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-21 |
| ANNUAL REPORT | 2021-03-09 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-04-01 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
