| Entity Name: | AMSURG PORT ORANGE ANESTHESIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Aug 2013 (11 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 17 May 2017 (8 years ago) |
| Document Number: | M13000005043 |
| FEI/EIN Number | 46-2512890 |
| Address: | 1A BURTON HILLS BLVD, Suite 300, NASHVILLE, TN, 37215, US |
| Mail Address: | 1A BURTON HILLS BLVD, Suite 300, NASHVILLE, TN, 37215, US |
| Place of Formation: | TENNESSEE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043654270 | 2013-04-18 | 2016-08-09 | 1A BURTON HILLS BLVD, ATTN: PROVIDER ENROLLMENT, NASHVILLE, TN, 372156187, US | 3635 S CLYDE MORRIS BLVD, SUITE 500, PORT ORANGE, FL, 321292300, US | |||||||||||||||||
|
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| Phone | +1 615-240-3809 |
| Fax | 6152341809 |
| Phone | +1 386-760-8151 |
Authorized person
| Name | MR. PHILLIP A. CLENDENIN |
| Role | PRESIDENT |
| Phone | 6156651283 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| SURGERY CENTER OF VOLUSIA, LLC | Member |
| Name | Role | Address |
|---|---|---|
| Reber Paige | Secretary | 1A BURTON HILLS BLVD, NASHVILLE, TN, 37215 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-23 | 1A BURTON HILLS BLVD, Suite 300, NASHVILLE, TN 37215 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-23 | 1A BURTON HILLS BLVD, Suite 300, NASHVILLE, TN 37215 | No data |
| LC STMNT OF RA/RO CHG | 2017-05-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-05-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-05-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-04 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-20 |
| CORLCRACHG | 2017-05-17 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-03-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
