| Entity Name: | TAMPA BAY CENTER FOR SPECIALIZED SURGERY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 27 Oct 1998 (26 years ago) |
| Date of dissolution: | 02 Jul 2021 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Jul 2021 (4 years ago) |
| Document Number: | P98000091382 |
| FEI/EIN Number | 593539542 |
| Address: | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL, 33703, US |
| Mail Address: | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL, 33703, US |
| ZIP code: | 33703 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366499923 | 2006-05-28 | 2013-04-10 | PO BOX 152199, TAMPA, FL, 336842199, US | 2808 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL, 336076306, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-874-2040 |
| Fax | 8138763438 |
Authorized person
| Name | MS. MARY ELIZABETH DYKEMA |
| Role | FACILITY ADMINISTATOR |
| Phone | 8138742040 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 912 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 2173001 |
| State | FL |
| Issuer | BWC |
| Number | 593535954200 |
| State | OH |
| Issuer | ACS |
| Number | 162422500 |
| State | KY |
| Issuer | STATE OF FLORIDA |
| Number | 912 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLYNN GREGORY T | Agent | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL, 33703 |
| Name | Role | Address |
|---|---|---|
| FLYNN GREGORY T | President | 2808 W. DR. MARTIN LUTHER KING, JR. BLVD., TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| FLYNN GREGORY T | Secretary | 2808 W. DR. MARTIN LUTHER KING, JR. BLVD., TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| FLYNN GREGORY T | Treasurer | 2808 W. DR. MARTIN LUTHER KING, JR. BLVD., TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| FLYNN GREGORY T | Director | 2808 W. DR. MARTIN LUTHER KING, JR. BLVD., TAMPA, FL, 33607 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000105993 | CENTER FOR SPECIALIZED SURGERY | EXPIRED | 2016-09-27 | 2021-12-31 | No data | P O BOX 152199, TAMPA, FL, 33684 |
| G04328900126 | CENTER FOR SPECIALIZED SURGERY | EXPIRED | 2004-11-23 | 2024-12-31 | No data | POST OFFICE BOX 152199, TAMPA, FL, 33684 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-07-02 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-07 | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL 33703 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-07 | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL 33703 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-07 | 1948 CAROLINA AVENUE, NE, SAINT PETERSBURG, FL 33703 | No data |
| REINSTATEMENT | 2007-09-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CANCEL ADM DISS/REV | 2006-11-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| CANCEL ADM DISS/REV | 2005-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-07-02 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-07-21 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-22 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
