| Entity Name: | FLORIDA LAKES ANESTHESIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Jun 2022 (3 years ago) |
| Document Number: | L22000262274 |
| FEI/EIN Number | 88-2891433 |
| Address: | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Mail Address: | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| ZIP code: | 33870 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023731239 | 2022-09-22 | 2022-09-22 | 4759 LAKEVIEW DR, SEBRING, FL, 338702005, US | 4759 LAKEVIEW DR, SEBRING, FL, 338702005, US | |||||||||||||||
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| Phone | +1 863-402-5600 |
| Fax | 8634025602 |
Authorized person
| Name | THOMAS LACKEY II |
| Role | OWNER |
| Phone | 8634025600 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LACKEY THOMAS CII | Agent | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Name | Role | Address |
|---|---|---|
| LACKEY THOMAS CII | Authorized Member | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Name | Role | Address |
|---|---|---|
| Ahmadi Bahram | Auth | 4759 LAKEVIEW DRIVE, SEBRING, FL, 33870 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-07-11 |
| Florida Limited Liability | 2022-06-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
