CREEKSIDE MEDICAL, P.S.

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Company Details

Legal Name:	CREEKSIDE MEDICAL, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	April 12th 2004
Expiration date:	30 Apr 2026
UBI Number:	602 385 672
ZIP code:	98685
City:	Vancouver
County:	CLARK
Home State:	WASHINGTON
Principal Office Street Address:	900 NE 139TH ST, STE 202, VANCOUVER, WA, 98685, UNITED STATES

Contact Details

E-Mail:	MVINCENT@CREEKSIDEMED.COM
Phone Number:	+1 360-816-1316

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
AMY NOPACHAI	Registered Agent	14808 NE 23RD AVE, VANCOUVER, WA, 98686-2290, UNITED STATES

Key Officers & Management

Name	Role	Address
JILL SPEAKER	Governing Person	3572 NW 112TH PLACE, PORTLAND, OR, 97229, UNITED STATES
AMY NOPACHAI	Governing Person	14808 NE 23RD AAVE, VANCOUVER, WA, 98686, UNITED STATES

National Provider Identifier

NPI Number:

1760529374

Link:

View on NPI website

Authorized Person:

Name:

CAROL DAVIS

Role:

CLINIC MANAGER

Phone:

3605669355

Taxonomy:

Selected Taxonomy:

363AM0700X - Medical Physician Assistant

Is Primary:

No

Selected Taxonomy:

208000000X - Pediatrics Physician

Is Primary:

No

Selected Taxonomy:

207R00000X - Internal Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 360-566-9355

Fax:

3608161327

Form 5500 Series

Employer Identification Number (EIN):

753153310

Plan Year:

2024

Number Of Participants:

18

Plan Name:

401(K)

Sponsor's telephone number:

3605669355

File:

Plan Year:

2023

Number Of Participants:

20

Plan Name:

401(K)

Sponsor's telephone number:

3605669355

File:

Plan Year:

2022

Number Of Participants:

23

Plan Name:

401(K)

Sponsor's telephone number:

3605669355

File:

Plan Year:

2021

Number Of Participants:

25

Plan Name:

401(K)

Sponsor's telephone number:

3605669355

File:

Plan Year:

2020

Number Of Participants:

26

Plan Name:

401(K)

Sponsor's telephone number:

3605669355

File:

Paycheck Protection Program

Jobs Reported:

25

Initial Approval Amount:

$248,740

Date Approved:

2020-04-14

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$238,740

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$240,828.98

Servicing Lender:

Riverview Bank

Use of Proceeds:

Payroll: $238,740

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