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EVERGREEN NEUROLOGY CLINIC PLLC
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Company Details
Legal Name:
EVERGREEN NEUROLOGY CLINIC PLLC
Jurisdiction:
WASHINGTON
Entity Type:
WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:
DOMESTIC ENTITY
Status:
Administratively Dissolved
Formation/ Registration Date:
August 24th 2007
Date of Dissolution:
December 2nd 2013
Expiration date:
31 Aug 2013
UBI Number:
602 756 604
ZIP code:
98034
City:
Kirkland
County:
KING
Home State:
WASHINGTON
Principal Office Street Address:
12303 NE 13TH LANE, SUITE 325, KIRKLAND, WA, 98034, UNITED STATES
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Registered Agent Information
Name
Role
Address
RAYMOND PARK
Registered Agent
12303 NE 130TH LN STE 325, KIRKLAND, WA, 98034, UNITED STATES
Key Officers & Management
Name
Role
RAYMOND PARK
Governing Person
National Provider Identifier
NPI Number:
1174710966
Link:
View on NPI website
Authorized Person:
Name:
DR. RAYMOND PARK
Role:
OWNER
Phone:
4258221214
Taxonomy:
Selected Taxonomy:
2084N0400X - Neurology Physician
Is Primary:
Yes
Contacts:
Phone:
+1 206-431-0138
Fax:
2062465819
Phone:
+1 425-822-1214
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