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NORTH KITSAP AMBULATORY SURGERY CENTER, LLC

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Company Details

Legal Name: NORTH KITSAP AMBULATORY SURGERY CENTER, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: December 31st 1984
Expiration date: 31 Dec 2025
UBI Number: 600 558 138
ZIP code: 98370
City: Poulsbo
County: KITSAP
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 20669 BOND ROAD NE SUITE 200, POULSBO, WA, 98370, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $250,264

Contact Details

E-Mail: CLS-CTARMSEVIDENCE@WOLTERSKLUWER.COM

Nature of Business

Other Services, AMBULATORY SURGERY CENTER

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Registered Agent Information

Name Role
C T CORPORATION SYSTEM Registered Agent

Key Officers & Management

Name Role
SARAH NEITZEL, DPM Governing Person
PAUL KREMER, MD Governing Person
BRIAN SHELTON Governing Person
JAMIE FOWLER Governing Person
WILLIAM (BILL) PETHICK Governing Person
MICHAEL JUNGKEIT M.D. Governing Person

National Provider Identifier

NPI Number:
1962402503
Certification Date:
2021-12-28

Authorized Person:

Name:
JAMIE FOWLER
Role:
CHIEF ADMINISTRATIVE OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3606972743

Form 5500 Series

Employer Identification Number (EIN):
911276412
Plan Year:
2010
Number Of Participants:
36
Plan Name:
401(K)
Sponsor's DBA Name:
PACIFIC SURGERY
Sponsor's telephone number:
Plan Administrator / Signatory:
SUSAN L SIMONS(Plan administrator) SUSAN L SIMONS(Employer/plan sponsor)
Plan Year:
2010
Number Of Participants:
36
Plan Name:
401(K)
Sponsor's DBA Name:
PACIFIC SURGERY
Sponsor's telephone number:
Plan Administrator / Signatory:
SUSAN SIMONS(Employer/plan sponsor)
Plan Year:
2009
Number Of Participants:
33
Plan Name:
401(K)
Sponsor's DBA Name:
PACIFIC SURGERY
Sponsor's telephone number:
Plan Administrator / Signatory:
SUSAN L SIMONS(Plan administrator)

History

Type Old value New value Date of change
Name change NORTH KITSAP AMBULATORY SURGERY CENTER, INC. NORTH KITSAP AMBULATORY SURGERY CENTER, LLC 2021-11-24
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