| Entity Name: | MIAMI BEACH SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Mar 2020 (5 years ago) |
| Document Number: | L20000090990 |
| FEI/EIN Number | 85-0585208 |
| Address: | 400 Arthur Godfrey Road, SUITE 512, MIAMI BEACH, FL 33140 |
| Mail Address: | 400 Arthur Godfrey Road, SUITE 512, MIAMI BEACH, FL 33140 |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578188983 | 2020-06-11 | 2020-09-04 | 400 W 41ST ST STE 512, MIAMI BEACH, FL, 331403517, US | 400 W 41ST ST STE 512, MIAMI BEACH, FL, 331403517, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 305-405-6910 |
| Fax | 3054056912 |
Authorized person
| Name | DR. GABRIEL ELLIS SALLOUM |
| Role | PRESIDENT |
| Phone | 3057427985 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OUT OF NETWORK PROVIDER |
| Number | 1578188983 |
| State | FL |
| Name | Role |
|---|---|
| JAIME M. COCO, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| SALLOUM, GABRIEL, MD | Manager | 410 WEST 41ST STREET, SUITE 512, MIAMI BEACH, FL 33140 |
| COUSINS, BENJAMIN, MD | Manager | 410 WEST 41ST STREET, SUITE 512, MIAMI BEACH, FL 33140 |
| HUSSEIN, TARIK, MD | Manager | 410 WEST 41ST STREET, SUITE 512, MIAMI BEACH, FL 33140 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-12 | 400 Arthur Godfrey Road, SUITE 512, MIAMI BEACH, FL 33140 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-12 | 400 Arthur Godfrey Road, SUITE 512, MIAMI BEACH, FL 33140 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-07-15 |
| ANNUAL REPORT | 2021-04-12 |
| Florida Limited Liability | 2020-03-26 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
