| Entity Name: | SUMMIT MEDICAL GROUP WEST FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Feb 2020 (5 years ago) |
| Document Number: | L20000037504 |
| FEI/EIN Number | 82-3972073 |
| Address: | 1559 Indian Rocks Rd S, Largo, FL, 33770, US |
| Mail Address: | 1559 Indian Rocks Rd S, Largo, FL, 33770, US |
| ZIP code: | 33770 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043782287 | 2018-12-28 | 2019-04-01 | 2410 NORTHSIDE DR, CLEARWATER, FL, 337612236, US | 11125 PARK BLVD STE 104, SEMINOLE, FL, 337724700, US | |||||||||||||||||
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| Phone | +1 727-499-0351 |
| Fax | 7277813312 |
| Phone | +1 727-709-0550 |
Authorized person
| Name | ANDREW HAYSLETT |
| Role | PRESIDENT |
| Phone | 7277090550 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HAYSLETT ANDREW L | Agent | 11125 PARK BOULEVARD SUITE 104-133, SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| HAYSLETT ANDREW | President | 1559 INDIAN ROCKS ROAD S, LARGO, FL, 33770 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-13 | 1559 Indian Rocks Rd S, Largo, FL 33770 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-13 | 1559 Indian Rocks Rd S, Largo, FL 33770 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-04-15 |
| Florida Limited Liability | 2020-02-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
