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CANYON CREEK CLINIC PLLC

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Company Details

Legal Name: CANYON CREEK CLINIC PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: December 7th 2001
Date of Dissolution: April 1st 2014
Expiration date: 31 Dec 2013
UBI Number: 602 166 211

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Registered Agent Information

Name Role Address
GARY B BLUME MD PHD Registered Agent 19125 N CREEK PKWY STE 204, BOTHELL, WA, 98011-8000, UNITED STATES

Key Officers & Management

Name Role Address
GARY BLUME Governing Person 14120 NE 183RD ST, #125, BOTHELL, WA, 98011, UNITED STATES

National Provider Identifier

NPI Number:
1447451216

Authorized Person:

Name:
MS. CATHY G KNOTH
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
4253984172
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