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PORT ORANGE ENDOSCOPY & SURGERY CENTER, LLC - Florida Company Profile

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Company Details

Entity Name: PORT ORANGE ENDOSCOPY & SURGERY CENTER, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 24 Mar 2023 (2 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 26 Apr 2023 (2 years ago)
Document Number: L23000136732
FEI/EIN Number 201388947
Address: 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174, US
Mail Address: 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174, US
ZIP code: 32174
City: Ormond Beach
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MORRIS SHYROLL Manager 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
MORRIS SHYROLL President 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
WEIS DAVID Manager 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
WEIS DAVID Vice President 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
DOMAYER CORY Manager 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
DOMAYER CORY Treasurer 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
THOMAS DEBORA MGRC 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
THOMAS DEBORA Secretary 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174
BROMME JEFF Agent 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714
Tolland John MD Mgr 550 MEMORIAL CIRCLE, SUITE G, ORMOND BEACH, FL, 32174

National Provider Identifier

NPI Number:
1619979580
Certification Date:
2025-05-05

Authorized Person:

Name:
CORY DOMAYER
Role:
CFO
Phone:

Taxonomy:

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

Contacts:

Fax:
3862316545

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000147787 ADVENTHEALTH SURGERY CENTER PORT ORANGE ACTIVE 2023-12-06 2028-12-31 - 1185 DUNLAWTON AVE., SUITE 100, PORT ORANGE, FL, 32127
G23000047925 ADVENTHEALTH SURGERY CENTER PORT ORANGE ACTIVE 2023-04-14 2028-12-31 - 1185 DUNLAWTON AVE, SUITE 100, PORT ORANGE, FL, 32127

Events

Event Type Filed Date Value Description
LC AMENDMENT 2023-04-26 - -
CONVERSION 2023-03-24 - CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P04000108356. CONVERSION NUMBER 700000237957

Documents

Name Date
ANNUAL REPORT 2025-01-21
ANNUAL REPORT 2024-03-06
LC Amendment 2023-04-26
Florida Limited Liability 2023-03-24

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Date of last update: 01 Aug 2025

Sources: Florida Department of State