NORTHWEST SPINE & SPORTS PHYSICIANS P.C.

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Company Details

Legal Name:	NORTHWEST SPINE & SPORTS PHYSICIANS P.C.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	April 28th 1998
Date of Dissolution:	August 1st 2012
Expiration date:	30 Apr 2012
UBI Number:	601 873 433
ZIP code:	98004
City:	Bellevue
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	1750 112TH NE STE D-258, BELLEVUE, WA, 98004, UNITED STATES

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Key Officers & Management

Name	Role
CAROLYN MARQUARDT	Governing Person
GARETT HYMAN	Governing Person
ANDREW COLE	Governing Person
IRENE YOUNG	Governing Person

National Provider Identifier

NPI Number:

1992878763

Link:

View on NPI website

Authorized Person:

Name:

MS. TINA MARIE LEAVITT

Role:

OPERATIONS MANAGER

Phone:

4254512272

Taxonomy:

Selected Taxonomy:

208100000X - Physical Medicine & Rehabilitation Physician

Is Primary:

Yes

Contacts:

Phone:

+1 425-451-2272

Fax:

4254511052

Form 5500 Series

Employer Identification Number (EIN):

911892592

Plan Year:

2012

Number Of Participants:

45

Plan Name:

CASH BALANCE

Sponsor's telephone number:

4254512272

File:

Plan Administrator / Signatory:

ANDREW J. COLE, M.D.(Plan administrator)

Plan Year:

2011

Number Of Participants:

51

Plan Name:

401(K)

Sponsor's telephone number:

4254512272

File:

Plan Administrator / Signatory:

ANDREW J. COLE, MD(Plan administrator)

Plan Year:

2011

Number Of Participants:

43

Plan Name:

401(K)

Sponsor's telephone number:

4254512272

File:

Plan Administrator / Signatory:

ANDREW J. COLE, MD(Plan administrator)

Plan Year:

2011

Number Of Participants:

45

Plan Name:

CASH BALANCE

Sponsor's telephone number:

4254512272

File:

Plan Administrator / Signatory:

ANDREW J. COLE, M.D.(Plan administrator)

Plan Year:

2010

Number Of Participants:

48

Plan Name:

CASH BALANCE

Sponsor's telephone number:

4254512272

File:

Plan Administrator / Signatory:

ANDREW J. COLE, M.D.(Plan administrator)

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