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JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC - Florida Company Profile

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Company Details

Entity Name: JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
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, US
ZIP code: 32806
City: Orlando
County: Orange
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Ohe Greg Auth 1414 KUHL AVENUE, ORLANDO, FL, 32806
Miller John Auth 1414 KUHL AVENUE, ORLANDO, FL, 32806
Carrasco Carlos Auth 1414 KUHL AVENUE, ORLANDO, FL, 32806
Deren Jeffrey MD Auth 1414 KUHL AVENUE, ORLANDO, FL, 32806
Ebaugh Michael MD Auth 1414 KUHL AVENUE, ORLANDO, FL, 32806
ZIKA RYAN W Agent 207 W. Gore St., Suite 201, ORLANDO, FL, 32806
- Manager -

U.S. Small Business Administration Profile

Phone Number:
Contact Person:
MILESSA LOWRY
User ID:
P3355154
Trade Name:
EUGENE JEWETT SURGERY CENTER

Unique Entity ID

Unique Entity ID:
SQC9LYPCLCN5
CAGE Code:
0Q7V7
UEI Expiration Date:
2025-12-19

Business Information

Doing Business As:
EUGENE JEWETT SURGERY CENTER
Activation Date:
2024-12-24
Initial Registration Date:
2024-12-16

National Provider Identifier

NPI Number:
1588312607
Certification Date:
2022-03-03

Authorized Person:

Name:
JAN LESLIE DIEDRICH
Role:
VICE PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Fictitious Names

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 - 1414 KUHL AVE., MP2, ORLANDO, FL, 32806
G22000148984 EUGENE JEWETT, MD, SURGERY CENTER ACTIVE 2022-12-05 2027-12-31 - 1414 KUHL AVE, MP 2, ORLANDO, FL, 32806
G21000089392 JEWETT INSTITUTE SURGERY CENTER ACTIVE 2021-07-07 2026-12-31 - 1414 KUHL AVENUE, MP2, ORLANDO, FL, 32806

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-02-07 60 Columbia Street, Suite 200, ORLANDO, FL 32806 -
REGISTERED AGENT ADDRESS CHANGED 2022-03-16 207 W. Gore St., Suite 201, ORLANDO, FL 32806 -
LC NAME CHANGE 2021-05-04 JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC -

Documents

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

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Date of last update: 02 Jul 2025

Sources: Florida Department of State