| Entity Name: | NEW SMYRNA BEACH AMBULATORY CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 03 Jun 1992 (33 years ago) |
| Document Number: | V40838 |
| FEI/EIN Number | 59-3136683 |
| Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 |
| Mail Address: | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497891501 | 2007-01-29 | 2020-08-22 | 612 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687327, US | 612 PALMETTO ST, NEW SMYRNA BEACH, FL, 321687327, US | |||||||||||||||||||||||
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| Fax | 3864099762 |
Authorized person
| Name | DR. MARK NAGRANI |
| Role | MEDICAL DIRECTOR |
| Phone | 3864235500 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1017 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 63D |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NAGRANI, MARK | Agent | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 |
| Name | Role | Address |
|---|---|---|
| NAGRANI, MARK | Managing Member | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-06 | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-06 | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-01-06 | NAGRANI, MARK | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-06 | 612 PALMETTO STREET, NEW SMYRNA BEACH, FL 32168 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-18 |
| ANNUAL REPORT | 2024-03-14 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-02-17 |
| ANNUAL REPORT | 2018-02-11 |
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-04-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
