| Entity Name: | VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 Jun 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 Oct 2024 (3 months ago) |
| Document Number: | L16000110382 |
| FEI/EIN Number | 30-0950557 |
| Address: | 1871 LPGA Blvd, Daytona Beach, FL 32117 |
| Mail Address: | 1871 LPGA Blvd., Daytona Beach, FL 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932657335 | 2016-09-14 | 2021-07-07 | 1871 LPGA BLVD, DAYTONA BEACH, FL, 321177108, US | 1871 LPGA BLVD, DAYTONA BEACH, FL, 321177108, US | |||||||||||||||||||||
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| Phone | +1 386-255-4596 |
| Phone | +1 386-366-8181 |
Authorized person
| Name | DR. ALBERT W GILLESPY |
| Role | C.E.O. |
| Phone | 3862554596 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE - AHCA |
| Number | 1396 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MERKEL, KIMBERLY | Agent | 1871 LPGA BLVD, DAYTONA BEACH, FL 32117 |
| Name | Role | Address |
|---|---|---|
| GILLESPY, MARK C, M.D. | Manager | 1075 MASON AVENUE, DAYTONA BEACH, FL 32117 |
| HATTEN, BRIAN R | Manager | 1075 MASON AVENUE, DAYTONA BEACH, FL 32117 |
| MCCALL, TODD A | Manager | 1075 MASON AVENUE, DAYTON BEACH, FL 32117 |
| GILLESPY, ALBERT W, M.D. | Manager | 1075 MASON AVENUE, DAYTONA BEACH, FL 32117 |
| BRYAN, JAMES M, M.D. | Manager | 1075 MASON AVENUE, DAYTONA BEACH, FL 32117 |
| MARTIN, JEFFREY | Manager | 1871 LPGA Blvd., Daytona Beach, FL 32117 |
| Matthews, Christopher, M.D. | Manager | 1871 LPGA Blvd., Daytona Beach, FL 32117 |
| Sims, Richard, M.D. | Manager | 1871 LPGA Blvd., Daytona Beach, FL 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-10-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-30 | MERKEL, KIMBERLY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-30 | 1871 LPGA BLVD, DAYTONA BEACH, FL 32117 | No data |
| LC AMENDMENT | 2018-06-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-16 | 1871 LPGA Blvd, Daytona Beach, FL 32117 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-16 | 1871 LPGA Blvd, Daytona Beach, FL 32117 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-10-11 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-03-05 |
| LC Amendment | 2018-06-22 |
| AMENDED ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2018-01-09 |
| AMENDED ANNUAL REPORT | 2017-02-21 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
