| Entity Name: | BAPTIST SOUTH SURGERY CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Dec 2022 (2 years ago) |
| Document Number: | L22000533274 |
| FEI/EIN Number | 92-1168204 |
| Address: | 14540 OLD ST. AUGUSTINE ROAD, MEDICAL OFFICE BUILDING 2, JACKSONVILLE, FL 32258 |
| Mail Address: | 14540 OLD ST. AUGUSTINE ROAD, MEDICAL OFFICE BUILDING 2, JACKSONVILLE, FL 32258 |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952017832 | 2023-01-25 | 2024-10-22 | 14540 OLD ST. AUGUSTINE ROAD, MEDICAL OFFICE BLDG. 2, JACKSONVILLE, FL, 322587418, US | 14540 OLD ST. AUGUSTINE ROAD, MEDICAL OFFICE BLDG. 2, JACKSONVILLE, FL, 322587418, US | |||||||||||||||
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| Phone | +1 904-648-0100 |
| Fax | 9046182159 |
Authorized person
| Name | CATHERINE GRAHAM |
| Role | SVP, CLIN SVC LN & AMB BUS DEV |
| Phone | 9042022230 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| TICKELL, KEITH | Agent | 841 PRUDENTIAL DRIVE, SUITE 1802, JACKSONVILLE, FL 32207 |
| Name | Role |
|---|---|
| BAPTIST - COMPASS SURGICAL VENTURES, LLC | Authorized Member |
| PAVILION HEALTH SERVICES, INC. | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000107330 | HORIZON SURGERY CENTER SOUTH | ACTIVE | 2023-09-07 | 2028-12-31 | No data | 14540 OLD ST. AUGUSTINE ROAD, MOB BLDG 2, JACKSONVILLE, FL, 32258 |
| G23000082693 | HORIZON SURGERY CENTER | ACTIVE | 2023-07-13 | 2028-12-31 | No data | 1577 ROBERTS DRIVE, JACKSONVILLE BEACH, FL, 32250 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-03 | 14540 OLD ST. AUGUSTINE ROAD, MEDICAL OFFICE BUILDING 2, JACKSONVILLE, FL 32258 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-03 |
| Florida Limited Liability | 2022-12-21 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
