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GRANT W. JACKSON, M.D., P.S.

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Company Details

Legal Name: GRANT W. JACKSON, M.D., P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: May 22nd 2008
Date of Dissolution: September 1st 2015
Expiration date: 31 May 2015
UBI Number: 602 834 330
ZIP code: 98563
City: Montesano
County: GRAYS HARBOR
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 319 E PIONEER, MONTESANO, WA, 98563, UNITED STATES

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Registered Agent Information

Name Role Address
HAGEN BATES & EDWARDS PS Registered Agent 110 W MARKET #202, ABERDEEN, WA, 98520, UNITED STATES

Key Officers & Management

Name Role
GRANT JACKSON Governing Person

National Provider Identifier

NPI Number:
1023274370

Authorized Person:

Name:
GRANT JACKSON
Role:
DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

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