| Entity Name: | FORT LAUDERDALE MEDICAL SURGICAL ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 20 Aug 2008 (17 years ago) |
| Document Number: | P08000077526 |
| FEI/EIN Number | 26-3508290 |
| Address: | 2301 WILTON DR, STE C-2, WILTON MANOR, FL 33305 |
| Mail Address: | 2301 WILTON DR, STE C-2, WILTON MANOR, FL 33305 |
| ZIP code: | 33305 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134473663 | 2012-11-06 | 2012-12-07 | 2301 WILTON DR, SUITE C2, WILTON MANORS, FL, 333051202, US | 2301 WILTON DR, SUITE C2, WILTON MANORS, FL, 333051202, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-567-5898 |
| Fax | 9545670395 |
Authorized person
| Name | TIMOTHY GOSHEN |
| Role | OWNER |
| Phone | 9545675898 |
Taxonomy
| Taxonomy Code | 208C00000X - Colon & Rectal Surgery Physician |
| License Number | OS8504 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266516600 |
| State | FL |
| Issuer | MEDICARE |
| Number | 57739 |
| Name | Role | Address |
|---|---|---|
| WHITTAKER, LAURIE S. | Agent | 15251 NE 18 AVE., STE. 11, NORTH MIAMI BEACH, FL 33162 |
| Name | Role | Address |
|---|---|---|
| GOSHEN, TIMOTHY | Director | 2301 WILTON DR, STE C-2, WILTON MANOR, FL 33305 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000100476 | FORT LAUDERDALE MEDICAL SURGICAL ASSOCIATES | ACTIVE | 2009-04-24 | 2029-12-31 | No data | 2301 WILTON DR, C 2, SUITE C-2, WILTON MANORS, FL, 33305 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-11-19 | 2301 WILTON DR, STE C-2, WILTON MANOR, FL 33305 | No data |
| CHANGE OF MAILING ADDRESS | 2009-11-19 | 2301 WILTON DR, STE C-2, WILTON MANOR, FL 33305 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-02-06 |
| ANNUAL REPORT | 2021-02-07 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-03-02 |
| ANNUAL REPORT | 2016-02-04 |
| ANNUAL REPORT | 2015-03-30 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3121557202 | 2020-04-16 | 0455 | PPP | 231 Wilton Drive, FORT LAUDERDALE, FL, 33305 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 24 Feb 2025
Sources: Florida Department of State
