| Entity Name: | JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Apr 2021 (4 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 04 May 2021 (4 years ago) |
| Document Number: | L21000188455 |
| FEI/EIN Number | 87-2667237 |
| Mail Address: | 1414 KUHL AVENUE, MP2, ORLANDO, FL 32806 |
| Address: | 60 Columbia Street, Suite 200, ORLANDO, FL 32806 |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588312607 | 2022-03-17 | 2022-03-17 | 65 STURTEVANT ST # MP65, ORLANDO, FL, 328062016, US | 60 COLUMBIA STREET, ORLANDO, FL, 32806, US | |||||||||||||||
|
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| Phone | +1 321-841-8199 |
| Phone | +1 757-677-6054 |
Authorized person
| Name | JAN LESLIE DIEDRICH |
| Role | VICE PRESIDENT |
| Phone | 3218418199 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ZIKA, RYAN W | Agent | 207 W. Gore St., Suite 201, ORLANDO, FL 32806 |
| Name | Role |
|---|---|
| HEALTHNET SERVICES, INC. | Manager |
| Name | Role | Address |
|---|---|---|
| Ohe, Greg | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Miller, John | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Carrasco, Carlos | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Deren, Jeffrey, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Ebaugh, Michael, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Jablonski, Michael, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Kupiszewski, Stanley, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| McFadden, Sean, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Mintzer, Craig, MD | Authorized Member | 1414 KUHL AVENUE, MP2 ORLANDO, FL 32806 |
| Hakim, MD, Jamal | Authorized Member | 1414 Kuhl Ave, MP 2 Orlando, FL 32806 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000148982 | DR. JEWETT SURGERY CENTER | ACTIVE | 2022-12-05 | 2027-12-31 | No data | 1414 KUHL AVE., MP2, ORLANDO, FL, 32806 |
| G22000148984 | EUGENE JEWETT, MD, SURGERY CENTER | ACTIVE | 2022-12-05 | 2027-12-31 | No data | 1414 KUHL AVE, MP 2, ORLANDO, FL, 32806 |
| G21000089392 | JEWETT INSTITUTE SURGERY CENTER | ACTIVE | 2021-07-07 | 2026-12-31 | No data | 1414 KUHL AVENUE, MP2, ORLANDO, FL, 32806 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-07 | 60 Columbia Street, Suite 200, ORLANDO, FL 32806 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-16 | 207 W. Gore St., Suite 201, ORLANDO, FL 32806 | No data |
| LC NAME CHANGE | 2021-05-04 | JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2022-03-16 |
| LC Name Change | 2021-05-04 |
| Florida Limited Liability | 2021-04-22 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
