| Entity Name: | WIREGRASS RANCH ASC HOLDINGS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Jan 2024 (a year ago) |
| Document Number: | L24000038048 |
| FEI/EIN Number | 99-1010158 |
| Address: | 14547 BRUCE B DOWNS BLVD, TAMPA, FL 33613 |
| Mail Address: | 14547 BRUCE B DOWNS BLVD, TAMPA, FL 33613 |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851467740 | 2006-11-24 | 2024-10-02 | 38135 MARKET SQ, ZEPHYRHILLS, FL, 335427505, US | 38135 MARKET SQ, ZEPHYRHILLS, FL, 335427505, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-780-1255 |
| Fax | 8137809773 |
| Phone | +1 813-780-8266 |
| Fax | 8137154150 |
Authorized person
| Name | GAURAV SOOD |
| Role | VP OF AMBULATORY SURGERY CENTERS |
| Phone | 3218418346 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 746 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | 746 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZIKA, RYAN | Agent | 207 W GORE, SUITE 201, ORLANDO, FL 32806 |
| Name | Role |
|---|---|
| HEALTHNET SERVICES, INC. | Authorized Member |
| Name | Role | Address |
|---|---|---|
| SOOD, GAURAV | Authorized Representative | 1414 KUHL AVE. MP 2, ORLANDO, FL 32806 |
| MOORE -JOHN- INC | Authorized Representative | No data |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000047328 | WIREGRASS RANCH AMBULATORY SURGERY CENTER | ACTIVE | 2024-04-08 | 2029-12-31 | No data | 14547 BRUCE B DOWNS BLVD, TAMPA, FL, 33613 |
| G24000047332 | WIREGRASS RANCH SPECIAL PROCEDURES CENTER | ACTIVE | 2024-04-08 | 2029-12-31 | No data | 38135 MARKET SQUARE DRIVE, SUITE 115, ZEPHYRHILLS, FL, 33542 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-05-22 | 14547 BRUCE B DOWNS BLVD, TAMPA, FL 33613 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-01-19 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
