NORTHWEST SURGICAL GROUP, P.C.

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Company Details

Legal Name:	NORTHWEST SURGICAL GROUP, P.C.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	February 23rd 1987
Date of Dissolution:	July 3rd 2018
Expiration date:	28 Feb 2018
UBI Number:	601 009 261

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Registered Agent Information

Name	Role	Address
WILLIAM C WILLIARD MD	Registered Agent	3920 CAPITAL MALL DR SW STE201, OLYMPIA, WA, 98502-0000, UNITED STATES

Key Officers & Management

Name	Role	Address
WILLIAM WILLIARD	Governing Person	3920 CAPITAL MALL DR SW STE201, OLYMPIA, WA, 98502, UNITED STATES

National Provider Identifier

NPI Number:

1114957875

Link:

View on NPI website

Authorized Person:

Name:

WILLIAM CLARENCE WILLIARD

Role:

PHYSICIAN

Phone:

3607541029

Taxonomy:

Selected Taxonomy:

174400000X - Specialist

Is Primary:

No

Selected Taxonomy:

208600000X - Surgery Physician

Is Primary:

Yes

Contacts:

Phone:

+1 360-754-1029

Fax:

3907547885

Form 5500 Series

Employer Identification Number (EIN):

860575860

Plan Year:

2016

Number Of Participants:

5

Sponsor's telephone number:

3607541029

File:

Plan Year:

2016

Number Of Participants:

4

Sponsor's telephone number:

3607541029

File:

Plan Year:

2015

Number Of Participants:

5

Sponsor's telephone number:

3607541029

File:

Plan Year:

2015

Number Of Participants:

5

Sponsor's telephone number:

3607541029

File:

Plan Year:

2014

Number Of Participants:

5

Sponsor's telephone number:

3607541029

File:

Plan Administrator / Signatory:

WILLIAM WILLIARD, M.D.(Plan administrator)

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