| Entity Name: | OLD MOULTRIE SURGICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Sep 1998 (26 years ago) |
| Document Number: | P98000076306 |
| FEI/EIN Number | 593572609 |
| Address: | 2460 OLD MOULTRIE RD., #3, ST. AUGUSTINE, FL, 32086, US |
| Mail Address: | 2460 OLD MOULTRIE RD., #3, ST. AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144326307 | 2006-09-15 | 2009-08-03 | P O BOX 3127, ST AUGUSTINE, FL, 320853127, US | 2460 OLD MOULTRIE ROAD, SUITE 3, ST AUGUSTINE, FL, 320864198, US | |||||||||||||||||||
|
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| Phone | +1 904-797-6627 |
| Fax | 9047976028 |
Authorized person
| Name | GEORGE EDWARD SADOWSKI |
| Role | MEDICAL DIRECTOR |
| Phone | 9047976627 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1089 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CAUDILL JEREMY | Agent | 2460 OLD MOULTRIE RD STE 3, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| CAUDILL JEREMY | Chief Financial Officer | 2460 OLD MOULTRIE RD., ST. AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2017-10-05 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
