EMERALD CITY SPORTS AND SPINE MEDICINE PLLC

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Company Details

Legal Name:	EMERALD CITY SPORTS AND SPINE MEDICINE PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	December 13th 2011
Expiration date:	31 Dec 2025
UBI Number:	603 165 103
ZIP code:	98004
City:	Bellevue
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	1600 116TH AVE NE, SUITE 206, BELLEVUE, WA, 98004-3056, UNITED STATES
Principal Office Mailing Address:	6924 SE ALLEN ST, MERCER ISLAND, WA, 98040-3357, UNITED STATES

Contact Details

E-Mail:	INFO@LAKEWASS.COM
Phone Number:	+1 425-818-0558

Nature of Business

Any Lawful Purpose, Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
GARRETT HYMAN	Registered Agent	1600 116TH AVE NE STE 206, BELLEVUE, WA, 98004-3056, UNITED STATES

Key Officers & Management

Name	Role
GARRETT HYMAN MD	Governing Person

National Provider Identifier

NPI Number:

1992074066

Link:

View on NPI website

Authorized Person:

Name:

GARRETT S HYMAN

Role:

PHYSICIAN OWNER

Phone:

2068528898

Taxonomy:

Selected Taxonomy:

261QM2500X - Medical Specialty Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 206-852-8898

Phone:

+1 425-818-0558

Fax:

8885573062

Form 5500 Series

Employer Identification Number (EIN):

454054764

Plan Year:

2023

Number Of Participants:

15

Plan Name:

401(K)

Sponsor's telephone number:

4258180558

File:

Plan Administrator / Signatory:

GARRETT S. HYMAN(Plan administrator)

Plan Year:

2022

Number Of Participants:

13

Plan Name:

401(K)

Sponsor's telephone number:

4258180558

File:

Plan Administrator / Signatory:

GARRETT S. HYMAN(Plan administrator)

Plan Year:

2021

Number Of Participants:

14

Plan Name:

401(K)

Sponsor's telephone number:

4258180558

File:

Plan Administrator / Signatory:

GARRETT S. HYMAN(Plan administrator)

Plan Year:

2020

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

4258180558

File:

Plan Administrator / Signatory:

GARRETT S. HYMAN(Plan administrator)

Plan Year:

2019

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

4258180558

Plan Administrator / Signatory:

GARRETT S. HYMAN(Plan administrator)

Paycheck Protection Program

Jobs Reported:

5

Initial Approval Amount:

$100,100

Date Approved:

2021-02-20

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$100,100

Race:

Unanswered

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$100,469.81

Servicing Lender:

Liberty Bank

Use of Proceeds:

Payroll: $100,095
Utilities: $1

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