| Entity Name: | INDEPENDENT SURGICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Mar 2018 (7 years ago) |
| Document Number: | L18000070734 |
| FEI/EIN Number | 82-4842269 |
| Address: | 1447 MEDICAL PARK BLVD, WELLINGTON, FL, 33414, US |
| Mail Address: | 1447 MEDICAL PARK BLVD, WELLINGTON, FL, 33414, US |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194220962 | 2018-03-26 | 2018-03-26 | 3461 FAIRLANE FARMS RD, WELLINGTON, FL, 334148752, US | 142 JOHN F KENNEDY DR, ATLANTIS, FL, 334621159, US | |||||||||||||||||||||||||
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| Phone | +1 561-766-1301 |
| Fax | 5616930539 |
| Phone | +1 561-439-1500 |
Authorized person
| Name | DR. ARTHUR HANSEN |
| Role | OWNER |
| Phone | 5617661301 |
Taxonomy
| Taxonomy Code | 2084B0002X - Obesity Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 2086X0206X - Surgical Oncology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRANCIFORTE LAUREN M | Agent | 142 JOHN F KENNEDY DR, ATLANTIS, FL, 33462 |
| Name | Role | Address |
|---|---|---|
| branciforte lauren | Auth | 1447 MEDICAL PARK BLVD, WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-04 | 1447 MEDICAL PARK BLVD, STE 405, WELLINGTON, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-04 | 1447 MEDICAL PARK BLVD, STE 405, WELLINGTON, FL 33414 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-18 | BRANCIFORTE, LAUREN MARIE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-18 | 142 JOHN F KENNEDY DR, ATLANTIS, FL 33462 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-04-13 |
| ANNUAL REPORT | 2021-06-13 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-29 |
| Florida Limited Liability | 2018-03-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
