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EXCELSIOR FAMILY MEDICINE, LLC

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Company Details

Legal Name: EXCELSIOR FAMILY MEDICINE, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: October 28th 2019
Expiration date: 31 Oct 2025
UBI Number: 604 526 517
ZIP code: 99201
City: Spokane
County: SPOKANE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 601 W MAIN AVE STE 1400, SPOKANE, WA, 99201-0635, UNITED STATES

Contact Details

E-Mail: RBURNETT@WORKWITH.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
WBM CORPORATE SERVICES LLC Registered Agent

Key Officers & Management

Name Role Address
ROBERT BURNETT Executor 159 S LINCOLN ST, SUITE 225, SPOKANE, WA, 99201-4418, UNITED STATES
EXCELSIOR WELLNESS Governing Person -

Unique Entity ID

Unique Entity ID:
FFX6JGA8U196
UEI Expiration Date:
2026-01-23

Business Information

Division Name:
EXCELSIOR FAMILY MEDICINE LLC
Activation Date:
2025-01-27
Initial Registration Date:
2023-03-06

National Provider Identifier

NPI Number:
1275179483
Certification Date:
2024-08-22

Authorized Person:

Name:
ANDREW RICHARD HILL
Role:
CHIEF EXECUTIVE OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
101Y00000X - Counselor
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5095887437

History

Type Old value New value Date of change
Name change FAMILY CARE SPOKANE, LLC EXCELSIOR FAMILY MEDICINE, LLC 2021-11-05
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