| Entity Name: | FLORIDA COASTAL SURGERY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 03 Sep 1997 (27 years ago) |
| Date of dissolution: | 09 Jan 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 09 Jan 2017 (8 years ago) |
| Document Number: | P97000076231 |
| FEI/EIN Number | 59-3473188 |
| Address: | 801 ANCHOR RODE DR, SUITE 100, NAPLES, FL 34103 |
| Mail Address: | 801 ANCHOR RODE DR, SUITE 100, NAPLES, FL 34103 |
| ZIP code: | 34103 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003812686 | 2005-06-28 | 2022-07-21 | 801 ANCHOR RODE DRIVE, SUITE 100, NAPLES, FL, 341032742, US | 801 ANCHOR RODE DRIVE, SUITE 100, NAPLES, FL, 341032742, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-263-1717 |
| Fax | 2394039410 |
Authorized person
| Name | MS. NICOLE M. BABB |
| Role | BILLING MANAGER |
| Phone | 2392631717 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1067 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UHC |
| Number | 313355 |
| State | FL |
| Issuer | BCBS |
| Number | 67Y |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZACK, LISA D, Dr. | Agent | 801 ANCHOR RODE DR., SUITE 100, NAPLES, FL 34103 |
| Name | Role | Address |
|---|---|---|
| ZACK, LISA D, Dr. | Director | 801 ANCHOR RODE DR, SUITE 100 NAPLES, FL 34103 |
| Name | Role | Address |
|---|---|---|
| Kovach, Bradley T, Dr. | Vice President | 801 ANCHOR RODE DR, SUITE 100 NAPLES, FL 34103 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-01-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-21 | ZACK, LISA D, Dr. | No data |
| REINSTATEMENT | 2010-03-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2002-03-13 | 801 ANCHOR RODE DR., SUITE 100, NAPLES, FL 34103 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2017-01-09 |
| ANNUAL REPORT | 2016-02-16 |
| ANNUAL REPORT | 2015-04-08 |
| ANNUAL REPORT | 2014-01-16 |
| ANNUAL REPORT | 2013-01-21 |
| ANNUAL REPORT | 2012-01-06 |
| ANNUAL REPORT | 2011-02-04 |
| REINSTATEMENT | 2010-03-11 |
| ANNUAL REPORT | 2008-08-26 |
| ANNUAL REPORT | 2007-03-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
