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OPA ORTHO, PLLC

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Company Details

Legal Name: OPA ORTHO, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Delinquent
Formation/ Registration Date: March 6th 2020
Expiration date: 31 Mar 2025
UBI Number: 604 587 867
ZIP code: 98122
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 601 BROADWAY FL 7, SEATTLE, WA, 98122-5330, UNITED STATES

Contact Details

E-Mail: CWALLER@OPAORTHO.COM
Phone Number: +1 206-518-6309

Nature of Business

Health Care, Social Assistance & Service Organization, ORTHOPEDIC SERVICES

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Registered Agent Information

Name Role Address
CONTROLLER Registered Agent 601 BROADWAY FL 7, SEATTLE, WA, 98122-5330, UNITED STATES

Key Officers & Management

Name Role Address
LAWRENCE HOLLAND Executor 601 BROADWAY FL 6, SEATTLE, WA, 98122-5330, UNITED STATES
LAWRENCE HOLLAND Governing Person -
JASON WILCOX Governing Person -

National Provider Identifier

NPI Number:
1821787334
Certification Date:
2024-07-26

Authorized Person:

Name:
AMANDA J PRICE
Role:
OPERATIONS SUPERVISOR
Phone:

Taxonomy:

Selected Taxonomy:
207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician
Is Primary:
No
Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
No
Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2066221644

Form 5500 Series

Employer Identification Number (EIN):
850965519
Plan Year:
2023
Number Of Participants:
0
Plan Name:
RETIREMENT PLAN
Sponsor's telephone number:
Plan Administrator / Signatory:
ALEX YEE(Plan administrator)
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