| Entity Name: | GENERAL SURGERY OF PALM BEACH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Mar 2009 (16 years ago) |
| Date of dissolution: | 05 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR REGISTERED AGENT |
| Event Date Filed: | 05 Sep 2014 (10 years ago) |
| Document Number: | L09000026814 |
| FEI/EIN Number | 320278341 |
| Address: | 3319 STATE ROAD 7, 207, WELLINGTON, FL, 33449 |
| Mail Address: | 3319 STATE ROAD 7, 207, WELLINGTON, FL, 33449 |
| ZIP code: | 33449 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104067222 | 2009-03-19 | 2012-08-06 | 11101 S CROWN WAY, SUITE 1, WELLINGTON, FL, 334148792, US | 3319 STATE ROAD 7, SUITE 207, WELLINGTON, FL, 334498094, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-795-9150 |
| Fax | 5617987700 |
| Phone | +1 561-753-1101 |
| Fax | 5617531105 |
Authorized person
| Name | DR. DAMARYS PEREZ |
| Role | OWNER |
| Phone | 5617531101 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003935000 |
| State | FL |
| Issuer | BCBSFL |
| Number | 0027V |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ADEN DARMAAN | Agent | 3319 STATE ROAD 7, SUITE 207, WELLINGTON, FL, 33449 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000073057 | PALM BEACH MEDICAL GROUP | EXPIRED | 2012-07-23 | 2017-12-31 | No data | 3319 SOUTH STATE ROAD 7, SUITE 207, WELLINGTON, FL, 33449 |
| G11000045625 | CLINICA VIDA | EXPIRED | 2011-05-12 | 2016-12-31 | No data | 10131 FOREST HILL BLVD., SUITE 203, WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR REGISTERED AGENT | 2014-09-05 | No data | No data |
| LC DISSOCIATION MEM | 2014-04-24 | No data | No data |
| LC AMENDMENT | 2013-11-08 | No data | No data |
| LC AMENDMENT | 2012-06-11 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-12-21 | 3319 STATE ROAD 7, 207, WELLINGTON, FL 33449 | No data |
| REINSTATEMENT | 2011-12-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-12-21 | 3319 STATE ROAD 7, 207, WELLINGTON, FL 33449 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| LC AMENDMENT | 2011-06-16 | No data | No data |
| REINSTATEMENT | 2010-10-10 | No data | No data |
| Name | Date |
|---|---|
| Admin. Diss. for Reg. Agent | 2014-09-05 |
| CORLCDSMEM | 2014-04-24 |
| Reg. Agent Resignation | 2014-04-24 |
| LC Amendment | 2013-11-08 |
| CORLCMMRES | 2013-10-17 |
| ANNUAL REPORT | 2013-04-23 |
| ANNUAL REPORT | 2012-09-04 |
| CORLCMMRES | 2012-06-11 |
| Reg. Agent Resignation | 2012-06-11 |
| LC Amendment | 2012-06-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
