| Entity Name: | LAKESIDE ANESTHESIA GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Apr 2024 (10 months ago) |
| Document Number: | L24000152702 |
| FEI/EIN Number | 992366684 |
| Address: | 3030 Hartley Rd., Ste. 310, JACKSONVILLE, FL, 32257, US |
| Mail Address: | 3030 Hartley Rd., Ste. 310, JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043063068 | 2024-04-09 | 2024-04-24 | 3020 HARTLEY RD STE 210, JACKSONVILLE, FL, 322578206, US | 9143 PHILIPS HWY STE 515, JACKSONVILLE, FL, 322561335, US | |||||||||||||||||
|
|||||||||||||||||||||
| Phone | +1 904-395-7772 |
| Phone | +1 904-395-4840 |
| Fax | 9043061351 |
Authorized person
| Name | MR. ANDREW WEAVER |
| Role | MANAGER |
| Phone | 9043957772 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WEAVER ANDREW | Agent | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| Name | Role | Address |
|---|---|---|
| WEAVER ROBERT VDMD | Manager | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| WEAVER J. PATRICK DMD | Manager | 3020 HARTLEY ROAD, SUITE 210, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-30 | 3030 Hartley Rd., Ste. 310, JACKSONVILLE, FL 32257 | No data |
| CHANGE OF MAILING ADDRESS | 2024-07-30 | 3030 Hartley Rd., Ste. 310, JACKSONVILLE, FL 32257 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-04-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
