| Entity Name: | LAKESHORE ANESTHESIA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Oct 2007 (17 years ago) |
| Document Number: | P07000111997 |
| FEI/EIN Number | 261209788 |
| Address: | 112 SILVER BELL CRESCENT, ROYAL PALM BEACH, FL, 33411 |
| Mail Address: | 112 SILVER BELL CRESCENT, ROYAL PALM BEACH, FL, 33411 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275789414 | 2008-08-07 | 2018-01-08 | PO BOX 24620 #CL 600017, WEST PALM BEACH, FL, 334164620, US | 39200 HOOKER HIGHWAY, BELLE GLADE, FL, 33430, US | |||||||||||||||||||||||||||
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| Phone | +1 561-723-9598 |
| Phone | +1 561-996-6571 |
| Fax | 5619962898 |
Authorized person
| Name | DR. GLENNON A. BROWN |
| Role | PRESIDENT |
| Phone | 5617239598 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | ME81129 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 259768300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BROWN GLENNON A | Agent | 112 SILVER BELL CRESCENT, ROYAL PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| BROWN GLENNON A | Director | 112 SILVER BELL CRESCENT, ROYAL PALM BEACH, FL, 33411 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-06 |
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-03 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-05 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
