| Entity Name: | PHYSICIANS SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jul 2001 (24 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 05 Oct 2022 (2 years ago) |
| Document Number: | M01000001695 |
| FEI/EIN Number | 59-2924183 |
| Address: | 5280 Corporate Drive, Suite C-250, Frederick, MD, 21703, US |
| Mail Address: | 5280 Corporate Drive, Suite C-250, Frederick, MD, 21703, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770588584 | 2005-06-17 | 2023-02-10 | PO BOX 715803, CINCINNATI, OH, 452715803, US | 4035 EVANS AVE, FT MYERS, FL, 339019308, US | |||||||||||||||||||||||||
|
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| Phone | +1 239-788-0604 |
| Fax | 2392300041 |
Authorized person
| Name | REBEKAH HENSLEY-MARTIN |
| Role | OFFICER AND AUTHORIZED OFFICIAL |
| Phone | 7578466946 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 815 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 062967700 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| NATIONAL SPINE AND PAIN CENTERS LLC | Member |
| QUINTAS GROUP, LLC | Member |
| Name | Role | Address |
|---|---|---|
| Kunkel Neil | Chie | 5280 Corporate Drive, Frederick, MD, 21703 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000052817 | NATIONAL SPINE & ORTHO SURGERY CENTER OF FT. MYERS | ACTIVE | 2022-04-26 | 2027-12-31 | No data | 4035 EVANS AVENUE, FORT MYERS, FL, 33901 |
| G99152900127 | LEE ISLAND COAST SURGERY CENTER | EXPIRED | 1999-06-01 | 2024-12-31 | No data | 4035 EVANS AVENUE, FORT MYERS, FL, 33901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-28 | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-28 | 5280 Corporate Drive, Suite C-250, Frederick, MD 21703 | No data |
| LC STMNT OF RA/RO CHG | 2022-10-05 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-05 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-05 | C T CORPORATION SYSTEM | No data |
| LC STMNT OF RA/RO CHG | 2016-01-27 | No data | No data |
| MERGER | 2001-07-30 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 500000037925 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-28 |
| ANNUAL REPORT | 2023-04-12 |
| CORLCRACHG | 2022-10-05 |
| ANNUAL REPORT | 2022-05-20 |
| AMENDED ANNUAL REPORT | 2021-09-29 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-04-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
