| Entity Name: | JACKSONVILLE BEACH SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Jul 2016 (9 years ago) |
| Document Number: | M16000005447 |
| FEI/EIN Number | 62-1825684 |
| Mail Address: | 340 SEVEN SPRINGS WAY, SUITE 600, BRENTWOOD, TN 37027 |
| Address: | 3316 S. Third Street, Ste 200, Jacksonville Beach, FL 32250 |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | TENNESSEE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497723720 | 2006-03-11 | 2016-11-01 | 3316 SOUTH THIRD STREET, STE 200, JACKSONVILLE BEACH, FL, 32250, US | 3316 SOUTH THIRD STREET, STE 200, JACKSONVILLE BEACH, FL, 32250, US | |||||||||||||||||||||||||
|
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| Phone | +1 904-247-8181 |
| Fax | 9042478101 |
Authorized person
| Name | JENNIFER B. BALDOCK |
| Role | SR VICE PRESIDENT |
| Phone | 6152345900 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1120 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 070933600 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BALDOCK, JENNIFER | MANAGER | 340 SEVEN SPRINGS WAY, SUITE 600 BRENTWOOD, TN 37027 |
| Name | Role | Address |
|---|---|---|
| BALDOCK, JENNIFER | vp | 340 SEVEN SPRINGS WAY, SUITE 600 BRENTWOOD, TN 37027 |
| O'Brien, Jeff | vp | Suite 600 340 Seven Springs Way, Brentwood, TN 37027 |
| Doherty, Dave | vp | Suite 600 340 Seven Springs Way, Brentwood, TN 37027 |
| Kennedy, Brett | vp | Suite 600 340 Seven Springs Way, Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| BALDOCK, JENNIFER | Secretary | 340 SEVEN SPRINGS WAY, SUITE 600 BRENTWOOD, TN 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-08 | 3316 S. Third Street, Ste 200, Jacksonville Beach, FL 32250 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-24 | 3316 S. Third Street, Ste 200, Jacksonville Beach, FL 32250 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-01 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-04-27 |
| Foreign Limited | 2016-07-07 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
