PENINSULA PAIN CLINIC, PLLC

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Company Details

Legal Name:	PENINSULA PAIN CLINIC, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	August 23rd 2001
Expiration date:	31 Aug 2025
UBI Number:	602 144 296
ZIP code:	98383
City:	Silverdale
County:	KITSAP
Home State:	WASHINGTON
Principal Office Street Address:	9220 RIDGETOP BLVD NW, SILVERDALE, WA, 98383-8583, UNITED STATES

Contact Details

E-Mail:	JJMHILLYER@COMCAST.NET
Phone Number:	+1 360-710-5005

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
ANDREW J MCNEIL, D.O.	Registered Agent	9220 RIDGETOP BLVD NW, SILVERDALE, WA, 98383-8583, UNITED STATES

Key Officers & Management

Name	Role	Address
JON HILLYER	Governing Person	2601 CHERRY, #200, BREMERTON, WA, 98310, UNITED STATES
ANDREW MCNEIL	Governing Person	-

National Provider Identifier

NPI Number:

1912376005

Link:

View on NPI website

Authorized Person:

Name:

TERRY PEXTON

Role:

MEDICAL DIRECTOR

Phone:

3604159110

Taxonomy:

Selected Taxonomy:

261Q00000X - Clinic/Center

Is Primary:

No

Selected Taxonomy:

332900000X - Non-Pharmacy Dispensing Site

Is Primary:

No

Selected Taxonomy:

261QP3300X - Pain Clinic/Center

Is Primary:

Yes

Contacts:

Phone:

+1 310-943-4180

Fax:

8884318819

Phone:

+1 360-415-9110

Fax:

3604790265

Form 5500 Series

Employer Identification Number (EIN):

912160314

Plan Year:

2019

Number Of Participants:

32

Plan Name:

401(K)

Sponsor's telephone number:

3604159110

File:

Plan Year:

2018

Number Of Participants:

30

Sponsor's telephone number:

3604159110

File:

Plan Administrator / Signatory:

DANA TIRAO(Plan administrator)

Plan Year:

2017

Number Of Participants:

25

Sponsor's telephone number:

3604159110

File:

Plan Administrator / Signatory:

RODINA TIRAO(Plan administrator)

Plan Year:

2016

Number Of Participants:

26

Sponsor's telephone number:

3604159110

File:

Plan Administrator / Signatory:

RODINA TIRAO(Plan administrator)

Plan Year:

2015

Number Of Participants:

24

Sponsor's telephone number:

3604159110

File:

Plan Administrator / Signatory:

RODINA TIRAO(Plan administrator)

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