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PROLIANCE MSSP ACO LLC

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Company Details

Legal Name: PROLIANCE MSSP ACO LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: June 13th 2019
Date of Dissolution: August 15th 2023
Expiration date: 30 Jun 2023
UBI Number: 604 474 217
ZIP code: 98104
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 805 MADISON ST STE 901, SEATTLE, WA, 98104-1172, UNITED STATES

Contact Details

E-Mail: P.WELLMAN@PROLIANCESURGEONS.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
PEGGY WELLMAN Registered Agent 805 MADISON ST STE 901, SEATTLE, WA, 98104-1172, UNITED STATES

Key Officers & Management

Name Role Address
MARK BARNHART Executor 805 MADISON ST STE 901, SEATTLE, WA, 98104-1172, UNITED STATES
TROY SIMONSON Governing Person -

National Provider Identifier

NPI Number:
1770137127

Authorized Person:

Name:
MR. MARK BARNHART
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

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