MAIN STREET FAMILY MEDICINE, PLLC

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Company Details

Legal Name:	MAIN STREET FAMILY MEDICINE, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	April 10th 2018
Expiration date:	30 Apr 2026
UBI Number:	604 264 624
ZIP code:	98665
City:	Vancouver
County:	CLARK
Home State:	WASHINGTON
Principal Office Street Address:	6000 NE 88TH ST, STE D-102, VANCOUVER, WA, 98665-0980, UNITED STATES
Principal Office Mailing Address:	4716 NE 44TH ST, VANCOUVER, WA, 98661-3203, UNITED STATES

Contact Details

E-Mail:	SBAKER@MAINSTREETFAMILYMED.COM
Phone Number:	+1 360-474-5904

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
STEVEN BAKER	Registered Agent	4716 NE 44TH ST, VANCOUVER, WA, 98661-3203, UNITED STATES

Key Officers & Management

Name	Role	Address
STEVEN BAKER	Executor	4716 NE 44TH ST, VANCOUVER, WA, 98661-3203, UNITED STATES
STEVEN BAKER	Governing Person	-

National Provider Identifier

NPI Number:

1023834439

Certification Date:

2024-12-02

Link:

View on NPI website

Authorized Person:

Name:

HALEIGH SCHWARTZ

Role:

OFFICE MANAGER

Phone:

3604745905

Taxonomy:

Selected Taxonomy:

261QP2300X - Primary Care Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 360-474-5905

Fax:

3606398017

Form 5500 Series

Employer Identification Number (EIN):

825499911

Plan Year:

2024

Number Of Participants:

19

Plan Name:

401(K)

Sponsor's telephone number:

3604745904

File:

Plan Year:

2023

Number Of Participants:

14

Plan Name:

401(K)

Sponsor's telephone number:

3604745904

File:

Plan Administrator / Signatory:

QIAN LIU(Plan administrator)

Plan Year:

2022

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

3604745904

File:

Plan Administrator / Signatory:

CHRISTINE RIMER(Plan administrator)

Plan Year:

2021

Number Of Participants:

6

Plan Name:

401(K)

Sponsor's telephone number:

3604745904

File:

Plan Administrator / Signatory:

CHRISTINE RIMER(Plan administrator)

Plan Year:

2020

Number Of Participants:

0

Plan Name:

401(K)

Sponsor's telephone number:

3604745904

File:

Plan Administrator / Signatory:

CAROL HO(Plan administrator)

History

Type	Old value	New value	Date of change
Name change	PACIFIC FAMILY MEDICINE, PLLC	MAIN STREET FAMILY MEDICINE, PLLC	2018-05-02

Paycheck Protection Program

Jobs Reported:

5

Initial Approval Amount:

$12,100

Date Approved:

2020-04-29

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$12,100

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$12,227.3

Servicing Lender:

Umpqua Bank

Use of Proceeds:

Payroll: $12,100

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