COLUMBIA MEDICAL ASSOCIATES, L.L.C.

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Company Details

Legal Name:	COLUMBIA MEDICAL ASSOCIATES, L.L.C.
Jurisdiction:	WASHINGTON
Entity Type:	WA LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Voluntarily Dissolved
Formation/ Registration Date:	April 7th 2004
Date of Dissolution:	November 15th 2023
Expiration date:	30 Apr 2024
UBI Number:	602 384 279
ZIP code:	98057
City:	Renton
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	1300 SW 27TH ST, RENTON, WA, 98057-2435, UNITED STATES

Contact Details

E-Mail:

ANNUALREPORTS@CSCGLOBAL.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
CORPORATION SERVICE COMPANY	Registered Agent	300 DESCHUTES WAY SW STE 208 MC-CSC1, TUMWATER, WA, 98501, UNITED STATES

Key Officers & Management

Name	Role
R JEFFREY MARKIN, MD	Governing Person
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Governing Person
SHAWNA MARIE SWEENEY	Governing Person
KELLY STANFORD	Governing Person

National Provider Identifier

NPI Number:

1073720538

Link:

View on NPI website

Authorized Person:

Name:

ALICIA SHOBER-KLOTZ

Role:

CREDENTIALING MANAGER

Phone:

5096886733

Taxonomy:

Selected Taxonomy:

261QM1300X - Multi-Specialty Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 509-688-6701

Fax:

5096886777

Form 5500 Series

Employer Identification Number (EIN):

200986848

Plan Year:

2017

Number Of Participants:

180

Sponsor's telephone number:

5096886700

File:

Plan Administrator / Signatory:

KELLY STANFORD(Plan administrator)

Plan Year:

2017

Number Of Participants:

180

Sponsor's telephone number:

5096886700

Plan Administrator / Signatory:

KELLY STANFORD(Plan administrator) KELLY STANFORD(Employer/plan sponsor)

Plan Year:

2017

Number Of Participants:

402

Sponsor's telephone number:

5096886700

File:

Plan Administrator / Signatory:

KELLY STANFORD(Plan administrator) KELLY STANFORD(Employer/plan sponsor)

Plan Year:

2016

Number Of Participants:

164

Sponsor's telephone number:

5096886700

File:

Plan Administrator / Signatory:

KELLY STANFORD(Plan administrator) KELLY STANFORD(Employer/plan sponsor)

Plan Year:

2016

Number Of Participants:

383

Sponsor's telephone number:

5096886700

File:

Plan Administrator / Signatory:

KELLY STANFORD(Plan administrator) KELLY STANFORD(Employer/plan sponsor)

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