| Entity Name: | CENTURION SURGERY CENTER OF JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Dec 2019 (5 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 22 Sep 2022 (2 years ago) |
| Document Number: | L19000295296 |
| FEI/EIN Number | 84-3958857 |
| Address: | 5191 First Coast Tech Parkway, 3rd Floor, Jacksonville, FL, 32224, US |
| Mail Address: | 5191 First Coast Tech Parkway, 3rd Floor, Jacksonville, FL, 32224, US |
| ZIP code: | 32224 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053059220 | 2022-05-26 | 2024-01-02 | 5191 FIRST COAST TECH PKWY, 1ST FLOOR, JACKSONVILLE, FL, 32224, US | 5191 FIRST COAST TECH PKWY, 1ST FLOOR, JACKSONVILLE, FL, 32224, US | |||||||||||||||
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| Phone | +1 904-593-5146 |
| Fax | 9045936642 |
Authorized person
| Name | ALICIA GROTH |
| Role | CREDENTIALING MANAGER |
| Phone | 9042562754 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BORON STEVEN | Agent | 5191 First Coast Tech Parkway, Jacksonville, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| Jacksonville Spine Center, PA | Manager | 5191 First Coast Tech Parkway, Jacksonville, FL, 32224 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000080511 | CENTURION SURGERY CENTER OF JACKSONVILLE | ACTIVE | 2022-07-06 | 2027-12-31 | No data | 10475 CENTURION PARKWAY NORTH, SUITE 201, JACKSONVILLE, FL, 32256 |
| G22000068240 | CENTURION SPINE & PAIN CENTERS | ACTIVE | 2022-06-03 | 2027-12-31 | No data | 5191 FIRST COAST TECH PARKWAY, SUITE 100, JACKSONVILLE, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-29 | BORON, STEVEN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 5191 First Coast Tech Parkway, 3rd Floor, Jacksonville, FL 32224 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-22 | 5191 First Coast Tech Parkway, 3rd Floor, Jacksonville, FL 32224 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-22 | 5191 First Coast Tech Parkway, 3rd Floor, Jacksonville, FL 32224 | No data |
| LC NAME CHANGE | 2022-09-22 | CENTURION SURGERY CENTER OF JACKSONVILLE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-02-22 |
| LC Name Change | 2022-09-22 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-06-29 |
| Florida Limited Liability | 2019-12-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
