| Entity Name: | PEACE RIVER SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Sep 2020 (4 years ago) |
| Document Number: | L20000279233 |
| FEI/EIN Number | 85-3047089 |
| Mail Address: | 4161 TAMIAMI TRAIL, SUITE 701, PORT CHARLOTTE, FL, 33952, US |
| Address: | 4130 Tamiami Trail, Unit 301, PORT CHARLOTTE, FL, 33952, US |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467101907 | 2022-03-22 | 2023-04-26 | 4130 TAMIAMI TRL UNIT 301, PORT CHARLOTTE, FL, 339529207, US | 4130 TAMIAMI TRL UNIT 301, PORT CHARLOTTE, FL, 339529207, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 941-629-5356 |
| Fax | 9416294987 |
Authorized person
| Name | DR. NICOLAI MEJEVOI |
| Role | MEDICAL DIRECTOR |
| Phone | 9416295356 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HOTCHKISS DAVID | Agent | 4161 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| HOTCHKISS DAVID | Owne | 4130 Tamiami Trail, Unit 301, PORT CHARLOTTE, FL, 33952 |
| NICOLAI MEJEVOI | Owne | 4130 Tamiami Trail, Unit 301, PORT CHARLOTTE, FL, 33952 |
| Strattan Melody | Owne | 4130 Tamiami Trail, Unit 301, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| BANDLER ADRIENNE | Authorized Person | 4161 TAMIAMI TRAIL, SUITE 701, PORT CHARLOTTE, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-23 | 4130 Tamiami Trail, Unit 301, PORT CHARLOTTE, FL 33952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-02 |
| Florida Limited Liability | 2020-09-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
