| Entity Name: | LEESBURG CARDIOVASCULAR ASSOCIATES, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 01 Oct 1998 (26 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | L98000002070 |
| FEI/EIN Number | 65-1080050 |
| Address: | 700 Doctors Court, Leesburg, FL 34748 |
| Mail Address: | 700 Doctors Court, Leesburg, FL 34748 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952346017 | 2006-06-20 | 2020-06-29 | 700 DOCTORS CT, LEESBURG, FL, 347487314, US | 700 DOCTORS CT, LEESBURG, FL, 347487314, US | |||||||||||||||||||||||||||
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| Phone | +1 352-787-9838 |
| Fax | 3527878705 |
Authorized person
| Name | TREVA D WIDDIS |
| Role | ADMINISTRATOR |
| Phone | 3527879838 |
Taxonomy
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255785100 |
| State | FL |
| Issuer | BCBS OF FLORIDA |
| Number | 21949 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Cook, R. Duane, Dr. | Agent | 700 Doctors Court, Leesburg, FL 34748 |
| Name | Role | Address |
|---|---|---|
| Cook , R. Duane, Dr. | Officer | 700 Doctors Court, Leesburg, FL 34748 |
| Richrdson, Robert J, Dr. | Officer | 700 Doctors Court, Leesburg, FL 34748 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000084207 | VILLAGES HEART SURGERY | EXPIRED | 2014-08-15 | 2019-12-31 | No data | PO BOX 3130, OCALA, FL, 34478-3130 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-08 | Cook, R. Duane, Dr. | No data |
| LC STMNT OF RA/RO CHG | 2018-08-13 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-08-13 | 700 Doctors Court, Leesburg, FL 34748 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-23 | 700 Doctors Court, Leesburg, FL 34748 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-23 | 700 Doctors Court, Leesburg, FL 34748 | No data |
| LC AMENDMENT | 2013-10-18 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-04 |
| CORLCRACHG | 2018-08-13 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-02-20 |
| ANNUAL REPORT | 2016-02-17 |
| ANNUAL REPORT | 2015-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
