| Entity Name: | QSS-SOUTHEAST CLINICAL SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 31 Jan 2013 (12 years ago) |
| Date of dissolution: | 22 Apr 2024 (9 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Apr 2024 (9 months ago) |
| Document Number: | L13000017513 |
| FEI/EIN Number | 46-2080437 |
| Address: | 4215 Edgewater Drive, orlando, FL, 32804, US |
| Mail Address: | 4215 Edgewater Drive, orlando, FL, 32804, US |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740521137 | 2013-03-08 | 2023-07-07 | PO BOX 4095, WAYNE, NJ, 074704095, US | 4215 EDGEWATER DR, ORLANDO, FL, 328042206, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 973-826-8080 |
| Fax | 8663093354 |
| Phone | +1 407-539-2000 |
| Fax | 4073980050 |
Authorized person
| Name | CAREEN E WILSON |
| Role | MANAGER |
| Phone | 9738941263 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113496900 |
| State | FL |
| Issuer | UHC |
| Number | 3593907 |
| State | FL |
| Issuer | CIGNA |
| Number | 1740521137 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DU0724 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF FL |
| Number | 004AH |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KOLTUN JEFFREY M | Agent | 150 Spartan Drive, MAITLAND, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| COHEN BARRY A | Manager | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| Byrnes John PAC | Clin | 4215 Edgewater Drive, orlando, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-04-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-04 | 150 Spartan Drive, SUITE 100, MAITLAND, FL 32751 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-28 | 4215 Edgewater Drive, orlando, FL 32804 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-28 | 4215 Edgewater Drive, orlando, FL 32804 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-04-22 |
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-07-14 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-03-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
