BELLEGROVE OB-GYN, INC., P.S.

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Company Details

Legal Name:	BELLEGROVE OB-GYN, INC., P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Voluntarily Dissolved
Formation/ Registration Date:	September 30th 1977
Date of Dissolution:	January 25th 2023
Expiration date:	30 Sep 2023
UBI Number:	600 249 764
ZIP code:	98072
City:	Woodinville
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	17123 NE 163RD PL, WOODINVILLE, WA, 98072-9182, UNITED STATES

Contact Details

E-Mail:	SPD@BOGINCPS.COM
Phone Number:	+1 206-818-5229

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
SUZANNE PARKER-DIXON	Registered Agent	17123 NE 163RD PL, WOODINVILLE, WA, 98072-9182, UNITED STATES

Key Officers & Management

Name	Role
ELIZABETH ANTON	Governing Person
DIONNE GALLAGHER	Governing Person
HEATHER MOORE	Governing Person
MITCHELL NUDELMAN	Governing Person
KEELY BROWN	Governing Person

National Provider Identifier

NPI Number:

1104931039

Link:

View on NPI website

Authorized Person:

Name:

MITCHELL E NUDELMAN

Role:

PRESIDENT

Phone:

4254550244

Taxonomy:

Selected Taxonomy:

261QA1903X - Ambulatory Surgical Clinic/Center

Is Primary:

No

Selected Taxonomy:

207V00000X - Obstetrics & Gynecology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 425-455-0244

Fax:

4254559411

Form 5500 Series

Employer Identification Number (EIN):

911004602

Plan Year:

2016

Number Of Participants:

51

Plan Name:

401(K)

Sponsor's telephone number:

4254550244

File:

Plan Year:

2015

Number Of Participants:

49

Plan Name:

401(K)

Sponsor's telephone number:

4254550244

File:

Plan Year:

2014

Number Of Participants:

49

Plan Name:

401(K)

Sponsor's telephone number:

4254550244

File:

Plan Administrator / Signatory:

SUZIE PARKER-DIXON(Plan administrator)

Plan Year:

2013

Number Of Participants:

45

Plan Name:

401(K)

Sponsor's telephone number:

4254550244

File:

Plan Administrator / Signatory:

SUZIE PARKER-DIXON(Plan administrator)

Plan Year:

2012

Number Of Participants:

46

Plan Name:

401(K)

Sponsor's telephone number:

4254550244

File:

Plan Administrator / Signatory:

SUZIE PARKER-DIXON(Plan administrator)

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