PEDIATRIC CRITICAL CARE ASSOCIATES, P.S.

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Company Details

Legal Name:	PEDIATRIC CRITICAL CARE ASSOCIATES, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	July 16th 1993
Date of Dissolution:	March 11th 2013
Expiration date:	31 Jul 2013
UBI Number:	601 479 541

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Registered Agent Information

Name	Role	Address
DANIEL P BRUTOCAO MD	Registered Agent	PEDIATRIC INTESNIVE CARE UNIT, 101 W 8TH AVE, SPOKANE, WA, 99203, UNITED STATES

Key Officers & Management

Name	Role
PETER GRAVES	Governing Person
DANIEL BRUTOCAO	Governing Person

National Provider Identifier

NPI Number:

1548210719

Link:

View on NPI website

Authorized Person:

Name:

DR. PETER W GRAVES

Role:

SECRETERY TRESURER

Phone:

5094745233

Taxonomy:

Selected Taxonomy:

207L00000X - Anesthesiology Physician

Is Primary:

No

Selected Taxonomy:

2080P0203X - Pediatric Critical Care Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 509-926-1770

Fax:

5092289542

Phone:

+1 509-474-7461

Fax:

5094745233

Form 5500 Series

Employer Identification Number (EIN):

911603823

Plan Year:

2011

Number Of Participants:

2

Sponsor's telephone number:

5094585233

File:

Plan Administrator / Signatory:

PETER GRAVES(Plan administrator)

Plan Year:

2011

Number Of Participants:

2

Sponsor's telephone number:

5094585233

File:

Plan Administrator / Signatory:

PETER GRAVES(Plan administrator)

Plan Year:

2011

Number Of Participants:

5

Plan Name:

401(K)

Sponsor's telephone number:

5094585233

File:

Plan Administrator / Signatory:

PETER W GRAVES, M.D.(Plan administrator)

Plan Year:

2010

Number Of Participants:

6

Plan Name:

401(K)

Sponsor's telephone number:

5094585233

File:

Plan Administrator / Signatory:

PETER W GRAVES, M.D.(Plan administrator)

Plan Year:

2009

Number Of Participants:

6

Plan Name:

401(K)

Sponsor's telephone number:

5094585233

File:

Plan Administrator / Signatory:

PETER W GRAVES, M.D.(Plan administrator)

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