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PROVIDENCE PHYSICIAN SERVICES CO.

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Company Details

Legal Name: PROVIDENCE PHYSICIAN SERVICES CO.
Jurisdiction: WASHINGTON
Entity Type: WA PROFIT CORPORATION
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: January 17th 1983
Expiration date: 31 Jan 2026
UBI Number: 600 503 827
ZIP code: 98057
City: Renton
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1801 LIND AVE SW, RENTON, WA, 98057-3368, UNITED STATES

Contact Details

E-Mail: CLS-CTARMSEVIDENCE@WOLTERSKLUWER.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
C T CORPORATION SYSTEM Registered Agent

Key Officers & Management

Name Role
GREGORY HOFFMAN Governing Person
ANNA NEWSOM Governing Person
JAMES D. WATSON Governing Person

Unique Entity ID

CAGE Code:
6WG36
UEI Expiration Date:
2020-01-14

Business Information

Doing Business As:
PROVIDENCE MEDICAL GROUP
Division Name:
PROVIDENCE MEDICAL GROUP
Activation Date:
2019-01-14
Initial Registration Date:
2013-05-08

Commercial and government entity program

CAGE number:
6WG36
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2024-01-16
CAGE Expiration:
2024-01-15
CAGE Link:
View company profile on CAGE website

Contact Information

POC:
SEAN M. DOUGLAS

National Provider Identifier

NPI Number:
1295135598
Link:
View on NPI website

Authorized Person:

Name:
BILLIE JEAN MOUNTS
Role:
CHIEF REIMBURSEMENT OFFICER
Phone:
4256873910

Taxonomy:

Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
No
Selected Taxonomy:
335E00000X - Prosthetic/Orthotic Supplier
Is Primary:
Yes

Contacts:

Phone:
+1 509-474-7317
Phone:
+1 509-465-3026

Labor Condition Applications

Case Number:
I-200-13226-462806
Program:
H-1B
Job Title:
GASTROENTEROLOGIST
SOC (ONET/OES) code:
29-1063
SOC (ONET/OES) occupation title:
Internists, General
Begin Date:
2014-07-15
End Date:
2017-07-14

Employment and Wage Information

Address:
SPOKANE, WA
Wage Rate Paid to Nonimmigrant Workers:
$209,622
Per:
Year
Prevailing Wage Rate:
$209,622
Case Number:
I-200-14017-073668
Program:
H-1B
Job Title:
PEDIATRIC PULMONARY STAFF PHYSICIAN
SOC (ONET/OES) code:
29-1069
SOC (ONET/OES) occupation title:
Physicians and Surgeons, All Other
Begin Date:
2014-07-01
End Date:
2017-06-30

Employment and Wage Information

Address:
SPOKANE, WA
Wage Rate Paid to Nonimmigrant Workers:
$175,503
Per:
Year
Prevailing Wage Rate:
$175,503
Case Number:
I-200-13302-549839
Program:
H-1B
Job Title:
RHEUMATOLOGIST
SOC (ONET/OES) code:
29-1063
SOC (ONET/OES) occupation title:
Internists, General
Begin Date:
2014-05-01
End Date:
2017-05-01

Employment and Wage Information

Address:
SPOKANE VALLEY, WA
Wage Rate Paid to Nonimmigrant Workers:
$126,818
Per:
Year
Prevailing Wage Rate:
$126,818
Case Number:
I-200-13302-119017
Program:
H-1B
Job Title:
GASTROENTEROLOGIST
SOC (ONET/OES) code:
29-1063
SOC (ONET/OES) occupation title:
Internists, General
Begin Date:
2014-05-01
End Date:
2017-05-01

Employment and Wage Information

Address:
SPOKANE, WA
Wage Rate Paid to Nonimmigrant Workers:
$126,818
Per:
Year
Prevailing Wage Rate:
$126,818
Case Number:
I-200-13067-697642
Program:
H-1B
Job Title:
PEDIATRIC ONCOLOGIST
SOC (ONET/OES) code:
29-1069
SOC (ONET/OES) occupation title:
Physicians and Surgeons, All Other
Begin Date:
2013-07-01
End Date:
2016-06-30

Employment and Wage Information

Address:
SPOKANE, WA
Wage Rate Paid to Nonimmigrant Workers:
$194,500
Per:
Year
Prevailing Wage Rate:
$162,282
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