| Entity Name: | TAMARAC SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 1999 (25 years ago) |
| Document Number: | L99000007876 |
| FEI/EIN Number | 65-0963549 |
| Mail Address: | 14201 DALLAS PKWY, FL 13, Dallas, TX, 75254, US |
| Address: | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL, 33319 |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265466288 | 2006-07-10 | 2024-10-24 | 4485 N STATE ROAD 7, LAUDERDALE LAKES, FL, 333195876, US | 4485 N STATE ROAD 7, LAUDERDALE LAKES, FL, 333195876, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-735-0096 |
| Fax | 9547358212 |
Authorized person
| Name | COLLIN LEMAISTRE |
| Role | OFFICER/AUTHORIZED OFFICIAL |
| Phone | 4692503640 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1074 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0023073 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | 490004691 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| OZAKTAY AMET MD | Vice President | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| LANES GERARDO M | Manager | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL, 33319 |
| STEPHEN LIPKIN M | Manager | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| TARBLE BEN MD | RVP | 14201 Dallas Parkway, Dallas, TX, 75254 |
| Name | Role | Address |
|---|---|---|
| Bowden James | Secretary | 14201 DALLAS PKWY, Dallas, TX, 75254 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000130842 | THE SURGERY CENTER OF FT LAUDERDALE | ACTIVE | 2021-09-29 | 2026-12-31 | No data | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL, 33319 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-04-20 | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL 33319 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-20 | 1200 South Pine Island Road, Plantation, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-23 | 4485 NORTH STATE ROAD 7, LAUDERDALE LAKES, FL 33319 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-12-01 | C T CORPORATION SYSTEM | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-01-31 |
| AMENDED ANNUAL REPORT | 2021-07-29 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-06-20 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-01-09 |
| AMENDED ANNUAL REPORT | 2016-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
