| Entity Name: | CITRUS UROLOGY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Jul 1996 (29 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 Jan 2012 (13 years ago) |
| Document Number: | P96000061785 |
| FEI/EIN Number | 593387636 |
| Address: | 3075 W GULF TO LAKE HWY, LECANTO, FL, 34461 |
| Mail Address: | PO BOX 1420, LECANTO, FL, 34461, US |
| ZIP code: | 34461 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821068289 | 2006-01-26 | 2012-05-02 | 3075 W GULF TO LAKE HWY, PO BOX 1420, LECANTO, FL, 344619228, US | 3075 W GULF TO LAKE HWY, LECANTO, FL, 344619228, US | |||||||||||||||||||||||||
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| Phone | +1 352-527-0102 |
| Fax | 3525278863 |
Authorized person
| Name | MS. LAYNE LOWREY |
| Role | ADMINISTRATOR |
| Phone | 3525270102 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1062 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 079242000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DESAUTEL MICHAEL GMD | Agent | 609 W. HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| DESAUTEL MICHAEL GDr. | President | 609 W HIGHLAND BLVD., INVERNESS, FL, 34452 |
| Name | Role | Address |
|---|---|---|
| KUMAR UDAYA Dr. | Treasurer | 3475 S SUNCOAST BLVD., HOMOSASSA SPRINGS, FL, 34448 |
| Name | Role | Address |
|---|---|---|
| DESAI PARESH GDr. | Director | 3475 S SUNCOAST BLVD., HOMOSASSA SPRINGS, FL, 34448 |
| SENERIZ MANUEL Dr. | Director | 609 W HIGHLAND BLVD., INVERNESS, FL, 34452 |
| AYYATHURAI RAJINIKANTH Dr. | Director | 609 W. Highland Terr., Inverness, FL, 34452 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000167266 | LECANTO SURGERY CENTER | ACTIVE | 2009-10-21 | 2029-12-31 | No data | P.O. BOX 1420, LECANTO, FL, 34461 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2013-02-22 | DESAUTEL, MICHAEL G, MD | No data |
| AMENDMENT | 2012-01-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2011-01-28 | 3075 W GULF TO LAKE HWY, LECANTO, FL 34461 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-05-12 | 3075 W GULF TO LAKE HWY, LECANTO, FL 34461 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1999-10-07 | 609 W. HIGHLAND BLVD., INVERNESS, FL 34452 | No data |
| AMENDMENT | 1999-03-30 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-03-05 |
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-03-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
