| Entity Name: | PINELLAS SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
PINELLAS SURGERY CENTER, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 21 Jan 2016 (9 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 21 Jan 2016 (9 years ago) |
| Document Number: | L16000011840 |
| FEI/EIN Number |
752563226
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4650 4TH ST N, ST PETERSBURG, FL, 33703, US |
| Mail Address: | 1414 Kuhl Ave., MP 2, Orlando, FL, 32806, US |
| ZIP code: | 33703 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003870825 | 2006-04-17 | 2020-10-09 | 4650 4TH ST N, ST PETERSBURG, FL, 337033802, US | 4650 4TH ST N, ST PETERSBURG, FL, 337033802, US | |||||||||||||||||||||||||
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| Phone | +1 727-527-1919 |
| Fax | 7275270714 |
Authorized person
| Name | SHANNON BRANGERS |
| Role | ADMINISTRATOR |
| Phone | 7275271919 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 878 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 079205500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PINELLAS SURGERY CENTER LLC 401(K) PROFIT SHARING PLAN & TRUST | 2022 | 752563226 | 2023-06-01 | PINELLAS SURGERY CENTER LLC | 30 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2023-06-01 |
| Name of individual signing | SHANNON BRANGERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7275271919 |
| Plan sponsor’s address | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
Signature of
| Role | Plan administrator |
| Date | 2022-03-30 |
| Name of individual signing | SHANNON BRANGERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7275271919 |
| Plan sponsor’s address | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
Signature of
| Role | Plan administrator |
| Date | 2021-04-05 |
| Name of individual signing | SHANNON BRANGERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7275271919 |
| Plan sponsor’s address | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
Signature of
| Role | Plan administrator |
| Date | 2020-06-29 |
| Name of individual signing | SHANNON BRANGERS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| OH Ambulatory Serivces Management, LLC | Manager | 1414 Kuhl Ave., MP 2, Orlando, FL, 32806 |
| CANIZARES GEORGE MD | Auth | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
| Burns Jennifer MD | Auth | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
| Pagano Paul MD | Auth | 4650 4TH ST N, ST PETERSBURG, FL, 33703 |
| Ohe Greg MD | Auth | 1414 KUHL AVE, ORLANDO, FL, 32806 |
| Smith Joseph | Auth | 1414 KUHL AVE, ORLANDO, FL, 32806 |
| Zika Ryan | Agent | 207 W. Gore St., Suite 201, ORLANDO, FL, 32806 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G98138900020 | CENTER FOR SPECIAL SURGERY | ACTIVE | 1998-05-18 | 2028-12-31 | - | 4650 4TH STREET NORTH, ST. PETERSBURG, FL, 33703 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-04-01 | 4650 4TH ST N, ST PETERSBURG, FL 33703 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-01 | 4650 4TH ST N, ST PETERSBURG, FL 33703 | - |
| CHANGE OF MAILING ADDRESS | 2022-03-16 | 4650 4TH ST N, ST PETERSBURG, FL 33703 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-16 | 207 W. Gore St., Suite 201, ORLANDO, FL 32806 | - |
| REGISTERED AGENT NAME CHANGED | 2021-03-26 | Zika, Ryan | - |
| CONVERSION | 2016-01-21 | - | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS A94000001415. CONVERSION NUMBER 700000157887 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-03-16 |
| ANNUAL REPORT | 2021-03-26 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-04-24 |
| Florida Limited Liability | 2016-01-21 |
Date of last update: 01 Mar 2025
Sources: Florida Department of State
