BLACKBURN & WHITNEY, M.D., P.S.

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Company Details

Legal Name:	BLACKBURN & WHITNEY, M.D., P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	April 24th 2002
Expiration date:	30 Apr 2026
UBI Number:	602 199 916
ZIP code:	98225
City:	Bellingham
County:	WHATCOM
Home State:	WASHINGTON
Principal Office Street Address:	2500 SQUALICUM PKWY, BUILDING 102, BELLINGHAM, WA, 98225-1856, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$13,552

Contact Details

E-Mail:	SSWEETIN@CSDLAW.COM
Phone Number:	+1 360-676-0972

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role
CJ SERVICES CORPORATION	Registered Agent

Key Officers & Management

Name	Role	Address
JAMES H BLACKBURN II, MD	Governing Person	3001 SQUALICUM PARKWAY #5, BELLINGHAM, WA, 98225, UNITED STATES
TIMOTHY M WHITNEY, MD	Governing Person	3001 SQUALICUM PARKWAY #5, BELLINGHAM, WA, 98225, UNITED STATES

National Provider Identifier

NPI Number:

1881184356

Certification Date:

2024-09-24

Link:

View on NPI website

Authorized Person:

Name:

TIMOTHY M WHITNEY

Role:

CO-MEDICAL DIRECTOR

Phone:

3606760972

Taxonomy:

Selected Taxonomy:

208200000X - Plastic Surgery Physician

Is Primary:

No

Selected Taxonomy:

2082S0099X - Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician

Is Primary:

No

Selected Taxonomy:

2082S0105X - Surgery of the Hand (Plastic Surgery) Physician

Is Primary:

No

Selected Taxonomy:

261QA1903X - Ambulatory Surgical Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 360-676-0972

Fax:

3606714423

Form 5500 Series

Employer Identification Number (EIN):

912176854

Plan Year:

2023

Number Of Participants:

39

Plan Name:

401(K)

Sponsor's telephone number:

3606760972

File:

Plan Administrator / Signatory:

CARRIE SMITH(Plan administrator)

Plan Year:

2022

Number Of Participants:

27

Plan Name:

401(K)

Sponsor's telephone number:

3606760972

File:

Plan Administrator / Signatory:

CARRIE SMITH(Plan administrator)

Plan Year:

2021

Number Of Participants:

25

Plan Name:

401(K)

Sponsor's telephone number:

3606760972

File:

Plan Administrator / Signatory:

CARRIE SMITH(Plan administrator)

Plan Year:

2020

Number Of Participants:

19

Plan Name:

401(K)

Sponsor's telephone number:

3606760972

File:

Plan Administrator / Signatory:

CARRIE SMITH(Plan administrator)

Plan Year:

2019

Number Of Participants:

17

Plan Name:

401(K)

Sponsor's telephone number:

3606760972

File:

Plan Administrator / Signatory:

CARRIE SMITH(Plan administrator)

Paycheck Protection Program

Jobs Reported:

13

Initial Approval Amount:

$108,200

Date Approved:

2020-04-07

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$108,200

Race:

White

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Veteran

Forgiveness Amount:

$108,985.56

Servicing Lender:

Whatcom Educational CU

Use of Proceeds:

Payroll: $108,200

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