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WATSON CLINIC ASC, LLC - Florida Company Profile

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Company Details

Entity Name: WATSON CLINIC ASC, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 25 Oct 2023 (2 years ago)
Document Number: L23000486890
FEI/EIN Number 93-4728316
Address: 1315 N Florida Ave., LAKELAND, FL, 33805-4502, US
Mail Address: 1430 LAKELAND HILLS BLVD, LAKELAND, FL, 33805, US
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Roth William Dr. Chief Executive Officer 1430 Lakeland Hills Blvd, Lakeland, FL, 33805
Hirsbrunner Jason Chie 1430 Lakeland Hills Blvd, Lakeland, FL, 33805
Pernicano Keith Secretary 1430 LAKELAND HILLS BLVD, LAKELAND, FL, 33805
Roth William Dr. Agent 1430 LAKELAND HILLS BLVD, LAKELAND, FL, 33805

National Provider Identifier

NPI Number:
1154199859
Certification Date:
2023-12-12

Authorized Person:

Name:
JASON HIRSBRUNNER
Role:
CAO
Phone:

Taxonomy:

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

Contacts:

Fax:
8662648519

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000143777 WATSON CLINIC SURGERY CENTER ACTIVE 2023-11-28 2028-12-31 - 1430 LAKELAND HILLS BLVD, LAKELAND, FL, 33805

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-02-05 1315 N Florida Ave., LAKELAND, FL 33805-4502 -
REGISTERED AGENT NAME CHANGED 2024-02-05 Roth, William Dr. -

Documents

Name Date
ANNUAL REPORT 2024-02-05
Florida Limited Liability 2023-10-25

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Date of last update: 01 Aug 2025

Sources: Florida Department of State