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JENNIFER W. CARL, MD, PC

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Company Details

Legal Name: JENNIFER W. CARL, MD, PC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: August 15th 2007
Date of Dissolution: February 28th 2017
Expiration date: 31 Aug 2017
UBI Number: 602 753 539
ZIP code: 98368
City: Port Townsend
County: JEFFERSON
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1192 57TH ST, PORT TOWNSEND, WA, 98368, UNITED STATES

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Registered Agent Information

Name Role Address
JENNIFER CARL Registered Agent 343 43RD ST, PORT TOWNSEND, WA, 98368-3330, UNITED STATES

Key Officers & Management

Name Role Address
JENNIFER CARL Governing Person 343 43RD ST, PORT TOWNSEND, WA, 98368, UNITED STATES

National Provider Identifier

NPI Number:
1245487156

Authorized Person:

Name:
JENNIFER W CARL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
Yes

Contacts:

Fax:
3603737054

Form 5500 Series

Employer Identification Number (EIN):
711042859
Plan Year:
2012
Number Of Participants:
1
Sponsor's telephone number:
Plan Administrator / Signatory:
JENNIFER CARL(Plan administrator) JENNIFER CARL(Employer/plan sponsor)
Plan Year:
2011
Number Of Participants:
1
Sponsor's telephone number:
Plan Administrator / Signatory:
JENNIFER CARL(Plan administrator)
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