ANESTHESIOLOGY CONSULTANTS OF WALLA WALLA, P.C.

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Company Details

Legal Name:	ANESTHESIOLOGY CONSULTANTS OF WALLA WALLA, P.C.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Voluntarily Dissolved
Formation/ Registration Date:	August 5th 1997
Date of Dissolution:	October 9th 2015
Expiration date:	31 Aug 2016
UBI Number:	601 808 793
Home State:	WASHINGTON

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Registered Agent Information

Name	Role	Address
TIMOTHY GCAUDILL	Registered Agent	1804 W 51ST AVE, KENNEWICK, WA, 99337, UNITED STATES

Key Officers & Management

Name	Role	Address
GARY REIBER	Governing Person	23 SWEET ONION LANE, WALLA WALLA, WA, 99362, UNITED STATES
ROBERT RICE	Governing Person	27 SHANGRI LA COURT, WALLA WALLA, WA, 99362, UNITED STATES
TIMOTHY CAUDILL	Governing Person	625 CATHERINE STREET, WALLA WALLA, WA, 99362, UNITED STATES
THEODORE SKAARUP	Governing Person	365 SOUTH FIRST STREET, WALLA WALLA, WA, 99362, UNITED STATES

National Provider Identifier

NPI Number:

1386631125

Link:

View on NPI website

Authorized Person:

Name:

TIMOTHY G CAUDILL

Role:

PRESIDENT

Phone:

5095291284

Taxonomy:

Selected Taxonomy:

207L00000X - Anesthesiology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 509-529-1284

Fax:

5095221798

Form 5500 Series

Employer Identification Number (EIN):

911844984

Plan Year:

2016

Number Of Participants:

3

Plan Name:

401(K)

Sponsor's telephone number:

5095291284

File:

Plan Year:

2013

Number Of Participants:

5

Sponsor's telephone number:

5095291284

File:

Plan Administrator / Signatory:

TIMOTHY G. CAUDILL, M.D.(Plan administrator)

Plan Year:

2013

Number Of Participants:

5

Sponsor's telephone number:

5095291284

File:

Plan Administrator / Signatory:

TIMOTHY G. CAUDILL, M.D.(Plan administrator)

Plan Year:

2012

Number Of Participants:

5

Sponsor's telephone number:

5095291284

File:

Plan Administrator / Signatory:

TIMOTHY G. CAUDILL, M.D.(Plan administrator)

Plan Year:

2011

Number Of Participants:

5

Sponsor's telephone number:

5095291284

File:

Plan Administrator / Signatory:

TIMOTHY G. CAUDILL, M.D.(Plan administrator)

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