| Entity Name: | SOUTHEASTERN CLINICAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jul 1992 (33 years ago) |
| Document Number: | V54884 |
| FEI/EIN Number | 593137319 |
| Address: | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804, US |
| Mail Address: | 1929 Caladium Place, Longwood, FL, 32750, US |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033162011 | 2006-05-18 | 2012-02-22 | 4215 EDGEWATER, ORLANDO, FL, 32804, US | 4215 EDGEWATER, ORLANDO, FL, 32804, US | |||||||||||||||||||||
|
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| Phone | +1 407-539-2000 |
| Fax | 4073980050 |
Authorized person
| Name | JOHN F BYRNES JR. |
| Role | PRESIDENT |
| Phone | 4075392000 |
Taxonomy
| Taxonomy Code | 363AS0400X - Surgical Physician Assistant |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 290643100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BYRNES JOHN J | Agent | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| BYRNES JOHN FJR. | President | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| BYRNES JOHN FJR. | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| CHAPMAN RICHARD KENT | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| BOERNER KEVIN | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| STELMASHENKO DEMETRIUS JR. | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| STEELE JOHN L | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| KONDOR CHRISTOPHER F | Director | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| CHAPMAN RICHARD KENT | Vice President | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| BOERNER KEVIN | Secretary | 4215 EDGEWATER DRIVE, ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2002-09-16 | SOUTHEASTERN CLINICAL SERVICES, INC. | No data |
| AMENDMENT | 1998-12-14 | No data | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 1996-05-06 | SOUTHEASTERN CLINICAL SERVICES, P.A. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
