| Entity Name: | COLLIER ENDOSCOPY & SURGERY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Apr 2001 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 Jun 2008 (17 years ago) |
| Document Number: | P01000036392 |
| FEI/EIN Number | 651093702 |
| Address: | 3439 PINE RIDGE ROAD, NAPLES, FL, 34109, US |
| Mail Address: | 3439 PINE RIDGE ROAD, NAPLES, FL, 34109, US |
| ZIP code: | 34109 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154538544 | 2007-05-17 | 2015-12-14 | 3439 PINE RIDGE RD, NAPLES, FL, 341093884, US | 3439 PINE RIDGE RD, NAPLES, FL, 341093884, US | |||||||||||||||||||||||||||||
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| Phone | +1 239-593-9599 |
| Fax | 2395934099 |
| Phone | +1 239-275-6678 |
| Fax | 2392755216 |
Authorized person
| Name | MS. MEGAN ALESSANDRA EVETTS |
| Role | BILLER |
| Phone | 2395939599 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | AS14960420 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 070928000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHARDUL NANAVATI | Agent | 3439 PINE RIDGE RD, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| Prathima Moorthy Irrevocable Trust | Officer | 3439 PINE RIDGE ROAD, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| NANAVATI SHARDUL M | Director | 3439 PINE RIDGE ROAD, NAPLES, FL, 34109 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-05-24 | 3439 PINE RIDGE ROAD, NAPLES, FL 34109 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-02-24 | SHARDUL NANAVATI | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-24 | 3439 PINE RIDGE RD, NAPLES, FL 34109 | No data |
| AMENDMENT | 2008-06-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-28 | 3439 PINE RIDGE ROAD, NAPLES, FL 34109 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-10 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-03-05 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-03-29 |
| ANNUAL REPORT | 2019-03-21 |
| ANNUAL REPORT | 2018-01-30 |
| ANNUAL REPORT | 2017-02-17 |
| ANNUAL REPORT | 2016-01-23 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
