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  5. ST. LUCIE SURGICAL CENTER, P.A.

ST. LUCIE SURGICAL CENTER, P.A.

Company Details

Entity Name: ST. LUCIE SURGICAL CENTER, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 26 Feb 1999 (26 years ago)
Document Number: P99000018517
FEI/EIN Number 650899311
Address: 1300 N LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950
Mail Address: 1300 N LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950
ZIP code: 34950
County: St. Lucie
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790761393 2005-12-16 2012-02-20 1300 N LAWNWOOD CIR, FORT PIERCE, FL, 349504884, US 1300 N LAWNWOOD CIR, FORT PIERCE, FL, 349504884, US

Contacts
Phone +1 772-429-5201
Fax 7724295204

Authorized person
Name DR. ANJANAYA PRASAD KORLIPARA
Role PRESIDENT
Phone 7724295201

Taxonomy
Taxonomy Code 261QA1903X - Ambulatory Surgical Clinic/Center
License Number 1107
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 070735000
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2013 650899311 2014-05-08 ST. LUCIE SURGICAL CENTER, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2014-05-08
Name of individual signing PRASAD KORLIPARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-08
Name of individual signing PRASAD KORLIPARA
Valid signature Filed with authorized/valid electronic signature
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2013 650899311 2014-05-08 ST. LUCIE SURGICAL CENTER, P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2014-05-08
Name of individual signing PRASAD KORLIPARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-08
Name of individual signing PRASAD KORLIPARA
Valid signature Filed with authorized/valid electronic signature
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2012 650899311 2013-05-01 ST. LUCIE SURGICAL CENTER, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Signature of
Role Plan administrator
Date 2013-05-01
Name of individual signing PATRICIA DE LA PAZ
Valid signature Filed with authorized/valid electronic signature
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2011 650899311 2012-06-12 ST. LUCIE SURGICAL CENTER, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Plan administrator’s name and address
Administrator’s EIN 650899311
Plan administrator’s name ST. LUCIE SURGICAL CENTER, P.A.
Plan administrator’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950
Administrator’s telephone number 7724295201

Signature of
Role Plan administrator
Date 2012-06-12
Name of individual signing PATRICIA DE LA PAZ
Valid signature Filed with authorized/valid electronic signature
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2010 650899311 2011-05-18 ST. LUCIE SURGICAL CENTER, P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Plan administrator’s name and address
Administrator’s EIN 650899311
Plan administrator’s name ST. LUCIE SURGICAL CENTER, P.A.
Plan administrator’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950
Administrator’s telephone number 7724295201

Signature of
Role Plan administrator
Date 2011-05-18
Name of individual signing PATRICIA DE LA PAZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-18
Name of individual signing PATRICIA DE LA PAZ
Valid signature Filed with authorized/valid electronic signature
ST. LUCIE SURGICAL CENTER 401(K) PLAN 2009 650899311 2010-07-01 ST. LUCIE SURGICAL CENTER, P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-11-01
Business code 621900
Sponsor’s telephone number 7724295201
Plan sponsor’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950

Plan administrator’s name and address
Administrator’s EIN 650899311
Plan administrator’s name ST. LUCIE SURGICAL CENTER, P.A.
Plan administrator’s address 1300 N. LAWNWOOD CIRCLE, FORT PIERCE, FL, 34950
Administrator’s telephone number 7724295201

Signature of
Role Plan administrator
Date 2010-07-01
Name of individual signing PATRICIA DE LA PAZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KATTA JOSEPH J Agent 1300 N. LAWNWOOD CIR., FT. PIERCE, FL, 34950

Director

Name Role Address
KATTA JOSEPH J Director 1900 NEBRASKA AVE., STE. 5, FT. PIERCE, FL, 34950
KORLIPARA A. PRASAD R M Director 1331 N LAWNWOOD CIR, FT. PIERCE, FL, 34950

Vice President

Name Role Address
KATTA JOSEPH J Vice President 1900 NEBRASKA AVE., STE. 5, FT. PIERCE, FL, 34950

Treasurer

Name Role Address
KATTA JOSEPH J Treasurer 1900 NEBRASKA AVE., STE. 5, FT. PIERCE, FL, 34950

President

Name Role Address
KORLIPARA A. PRASAD R M President 1331 N LAWNWOOD CIR, FT. PIERCE, FL, 34950

Secretary

Name Role Address
KORLIPARA A. PRASAD R M Secretary 1331 N LAWNWOOD CIR, FT. PIERCE, FL, 34950

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data

Related by officers

KATTA JOSEPH J

ST. LUCIE DIAGNOSTIC CORPORATION JOSEPH J. KATTA, M.D., P.A. TREASURE COAST SURGICAL CENTER, INC. GULFSTREAM ANESTHESIA ASSOCIATES, INC.

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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