| Entity Name: | ORTHOPAEDIC SURGERY CENTER OF CLEARWATER, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 Aug 1999 (25 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L99000005327 |
| FEI/EIN Number | 593594816 |
| Address: | 402 JEFFORDS STREET, CLEARWATER, FL, 33756 |
| Mail Address: | 402 JEFFORDS STREET, CLEARWATER, FL, 33756 |
| ZIP code: | 33756 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982788071 | 2006-10-25 | 2012-04-30 | 402 JEFFORDS STREET, CLEARWATER, FL, 33756, US | 402 JEFFORDS STREET, CLEARWATER, FL, 33756, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 727-448-0822 |
| Fax | 7274477044 |
Authorized person
| Name | DANIEL SMITH |
| Role | DIRECTOR OF NURSING |
| Phone | 7274480822 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1122 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA PPO |
| Number | 7544268 |
| State | FL |
| Issuer | MEDICAID |
| Number | 075143000 |
| State | FL |
| Issuer | AETNA HMO |
| Number | 2602599 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 490005251 |
| State | FL |
| Issuer | STATE LIC. |
| Number | 1122 |
| State | FL |
| Issuer | BCBS |
| Number | 69H |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEBB VENUS D | Agent | 402 JEFFORDS ST, CLEARWATER, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| PIAZZA MICHAEL R | Managing Member | 1011 JEFFORDS STREET, BLDG. D, CLEARWATER, FL, 33756 |
| ROTHBERG MICHAEL L | Managing Member | 430 MORTON PLANT STREET, SUITE 301, CLEARWATER, FL, 33756 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REINSTATEMENT | 2016-10-24 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-04-30 | 402 JEFFORDS ST, CLEARWATER, FL 33756 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-04-30 | WEBB, VENUS D | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-11 | 402 JEFFORDS STREET, CLEARWATER, FL 33756 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-03-13 | 402 JEFFORDS STREET, CLEARWATER, FL 33756 | No data |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2021-09-20 |
| ANNUAL REPORT | 2020-04-29 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-17 |
| REINSTATEMENT | 2016-10-24 |
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-30 |
| CORLCMMRES | 2013-01-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
