| Entity Name: | TALLAHASSEE ENDOSCOPY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jan 1991 (34 years ago) |
| Document Number: | S27342 |
| FEI/EIN Number | 593050876 |
| Address: | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| Mail Address: | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740201607 | 2006-07-23 | 2008-06-05 | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 323085314, US | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 323085314, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-205-8404 |
| Fax | 8502161321 |
Authorized person
| Name | CHARLOTTE L MADANI |
| Role | BUSINESS OFFICE MANAGER |
| Phone | 8502058404 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 749 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 61E |
| State | FL |
| Issuer | FLORIDA MEDICAID NUMBER |
| Number | 07069900 |
| State | FL |
| Issuer | RRMCR PROVIDER NUMBER |
| Number | 490001580 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ, ANDRES F | Agent | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ANDRES F | President | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ ANDRES F | Director | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| MANGAN MICHAEL J. | Director | 2400 MICCOSUKEE ROAD, TALLAHASSEE, FL |
| SINGH HARDEEP | Director | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| SOMERSET JOSHUA D | Director | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| COTTRELL CHARLES R | Director | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| GAO HONG F | Director | 2400 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| MANGAN MICHAEL J. | Secretary | 2400 MICCOSUKEE ROAD, TALLAHASSEE, FL |
| Name | Role | Address |
|---|---|---|
| MANGAN MICHAEL J. | Treasurer | 2400 MICCOSUKEE ROAD, TALLAHASSEE, FL |
| Name | Role | Address |
|---|---|---|
| SINGH HARDEEP | Vice President | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| SOMERSET JOSHUA D | Vice President | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| COTTRELL CHARLES R | Vice President | 2400 MICCOSUKEE RD, TALLAHASSEE, FL, 32308 |
| GAO HONG F | Vice President | 2400 MICCOSUKEE ROAD, TALLAHASSEE, FL, 32308 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 1994-02-21 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
