| Entity Name: | FORT LAUDERDALE SURGICAL SPECIALISTS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Jun 2005 (20 years ago) |
| Document Number: | P05000086094 |
| FEI/EIN Number | 510546134 |
| Address: | 5645 CORAL RIDGE DRIVE, #348, Coral Springs, FL, 33076, US |
| Mail Address: | 5645 CORAL RIDGE DRIVE, #348, PARKLAND, FL, 33076, US |
| ZIP code: | 33076 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679665129 | 2006-09-29 | 2007-09-18 | 4801 N FEDERAL HWY, SUITE 101, FORT LAUDERDALE, FL, 333084618, US | 4801 N FEDERAL HWY, SUITE 101, FORT LAUDERDALE, FL, 333084618, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-202-0242 |
| Fax | 9542020243 |
Authorized person
| Name | JONATHAN SCOTT LEVINE |
| Role | OWNER/ PRESIDENT |
| Phone | 9542020242 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | ME42654 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 374861800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Levine Jonathan S | Agent | 5645 CORAL RIDGE DRIVE, Coral Springs, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| Levine Jonathan S | President | 5645 CORAL RIDGE DRIVE, Coral Springs, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| Levine Jonathan S | Director | 5645 CORAL RIDGE DRIVE, Coral Springs, FL, 33076 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-07 | 5645 CORAL RIDGE DRIVE, #348, Coral Springs, FL 33076 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-07 | 5645 CORAL RIDGE DRIVE, #348, Coral Springs, FL 33076 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-03 | 5645 CORAL RIDGE DRIVE, #348, Coral Springs, FL 33076 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-06-09 | Levine, Jonathan S | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-02-18 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-02-27 |
| ANNUAL REPORT | 2018-09-03 |
| ANNUAL REPORT | 2017-02-16 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
