| Entity Name: | ST. LUCIE SURGICAL ASSOCIATES, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Jul 2007 (18 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P07000081011 |
| FEI/EIN Number | 260637456 |
| Address: | 8483 S. US HIGHWAY 1, SUITE 19, PORT ST. LUCIE, FL, 34952, US |
| Mail Address: | PO BOX 7665, PORT ST. LUCIE, FL, 34985, US |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770730459 | 2008-08-25 | 2008-09-30 | PO BOX 7665, PORT ST LUCIE, FL, 349857665, US | 8483 S US HIGHWAY 1, SUITE 19, PORT ST LUCIE, FL, 349523360, US | |||||||||||||||||||||||||||
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| Phone | +1 772-873-8501 |
| Fax | 7728738516 |
Authorized person
| Name | DR. IAN ANTHONY CONCILIO |
| Role | OWNER/PHYSICIAN |
| Phone | 7728738501 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 2086S0127X - Trauma Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 2086X0206X - Surgical Oncology Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CONCILIO IAN A | Agent | 9743 SAVANNAH ESTATES DR., LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| CONCILIO IAN A | Director | PO BOX 7665, PORT SAINT LUCIE, FL, 34985 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-07-22 | 8483 S. US HIGHWAY 1, SUITE 19, PORT ST. LUCIE, FL 34952 | No data |
| CHANGE OF MAILING ADDRESS | 2007-07-18 | 8483 S. US HIGHWAY 1, SUITE 19, PORT ST. LUCIE, FL 34952 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000649480 | ACTIVE | 1000000175190 | ST LUCIE | 2010-06-03 | 2030-06-09 | $ 450.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, FORT PIERCE SERVICE CENTER, 337 N US HIGHWAY 1 STE 207-B, FORT PIERCE FL349504255 |
| J10000796273 | LAPSED | 1000000175189 | ST LUCIE | 2010-06-03 | 2020-07-28 | $ 2,095.94 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, FORT PIERCE SERVICE CENTER, 337 N US HIGHWAY 1 STE 207-B, FORT PIERCE FL349504255 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-04-07 |
| ANNUAL REPORT | 2008-07-22 |
| Domestic Profit | 2007-07-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
