| Entity Name: | ST. BARBARA'S SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 May 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 Nov 2022 (2 years ago) |
| Document Number: | L21000221787 |
| FEI/EIN Number | 86-3920956 |
| Mail Address: | 44 BARKLEY CIRCLE, FORT MYERS, FL, 33907, US |
| Address: | 44 Barkley Circle, Fort Myers, FL, 33907, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053031872 | 2022-08-31 | 2024-01-23 | 44 BARKLEY CIR, FORT MYERS, FL, 339077530, US | 1745 HERITAGE TRL, NAPLES, FL, 341127591, US | |||||||||||||||||||||||||||||
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| Phone | +1 239-985-7171 |
| Fax | 2399857118 |
| Phone | +1 239-350-3389 |
| Fax | 2393503390 |
Authorized person
| Name | LEWIS WOODELL |
| Role | VP OF RCM |
| Phone | 8172916293 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QS0132X - Ophthalmologic Surgery Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PTAN |
| Number | RB456 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| FLORIDA EYE HEALTH SERVICES, LLC | Authorized Member |
| Name | Role | Address |
|---|---|---|
| Beck Ashley | Chief Executive Officer | 44 BARKLEY CIRCLE, FORT MYERS, FL, 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-12 | 44 Barkley Circle, Fort Myers, FL 33907 | No data |
| LC AMENDMENT | 2022-11-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-12 |
| ANNUAL REPORT | 2023-03-22 |
| LC Amendment | 2022-11-21 |
| ANNUAL REPORT | 2022-04-27 |
| Florida Limited Liability | 2021-05-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
