| Entity Name: | GULF COAST ENDOSCOPY CENTER OF VENICE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Sep 1999 (25 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 11 Jan 2012 (13 years ago) |
| Document Number: | L99000005696 |
| FEI/EIN Number | 65-0954372 |
| Address: | 1220 E. VENICE AVENUE, VENICE, FL 34285 |
| Mail Address: | 1220 E. VENICE AVENUE, VENICE, FL 34285 |
| ZIP code: | 34285 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962466847 | 2006-04-17 | 2009-03-09 | 1220 E VENICE AVE, VENICE, FL, 342857151, US | 1220 E VENICE AVE, VENICE, FL, 342857151, US | |||||||||||||||||||||||||||||
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| Phone | +1 636-938-6868 |
| Fax | 6369381487 |
| Phone | +1 941-484-5000 |
| Fax | 9414844414 |
Authorized person
| Name | MS. TERRI LOPEZ |
| Role | ADMINISTRATOR |
| Phone | 9414845000 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1117 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 070889500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KONDAPALLI, RAVI M.D. | Agent | 825 VENETIAN PARKWAY, VENICE, FL 34285 |
| Name | Role | Address |
|---|---|---|
| FELMAN, ROBERT M.D. | Manager | 1041 RIDGEWOOD AVE, VENICE, FL 34285 |
| KONDAPALLI, RAVI M.D. | Manager | 825 VENETIAN PARKWAY, VENICE, FL 34285 |
| Durrett, Scott | Manager | 1220 E. VENICE AVENUE, VENICE, FL 34285 |
| Taylor, Caren | Manager | 1220 E. VENICE AVENUE, VENICE, FL 34285 |
| Name | Role | Address |
|---|---|---|
| Agnello, Katie | Mgr | 825 Venetian Parkway, Venice, FL 34285 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000092191 | GULF COAST ENDOSCOPY AND SURGERY CENTER | ACTIVE | 2011-09-20 | 2026-12-31 | No data | 1220 E VENICE AVE, VENICE, FL, 34285 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2012-01-11 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-10 | 825 VENETIAN PARKWAY, VENICE, FL 34285 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-01-10 | KONDAPALLI, RAVI M.D. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-01-28 | 1220 E. VENICE AVENUE, VENICE, FL 34285 | No data |
| CHANGE OF MAILING ADDRESS | 2009-01-28 | 1220 E. VENICE AVENUE, VENICE, FL 34285 | No data |
| REINSTATEMENT | 2000-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-29 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-01-07 |
| ANNUAL REPORT | 2021-01-26 |
| AMENDED ANNUAL REPORT | 2020-11-20 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-10 |
| AMENDED ANNUAL REPORT | 2017-11-06 |
| ANNUAL REPORT | 2017-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
