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PUGET SOUND FAMILY PHYSICIANS, PLLC

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Company Details

Legal Name: PUGET SOUND FAMILY PHYSICIANS, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: December 30th 1997
Date of Dissolution: April 1st 2015
Expiration date: 31 Dec 2014
UBI Number: 601 841 953

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Registered Agent Information

Name Role Address
GINGER BLAKENEY Registered Agent 7315 212TH ST SW STE 101, EDMONDS, WA, 98026-7610, UNITED STATES

Key Officers & Management

Name Role Address
HAL CLARK Governing Person 7315 - 212TH STREET SW, SUITE 101, EDMONDS, WA, 98026, UNITED STATES
GINGER BLAKENEY Governing Person 7315 - 212TH STREET SW, SUITE 101, EDMONDS, WA, 98026, UNITED STATES
I ERIC ROMMEN Governing Person 7315 - 212TH STREET SW, SUITE 101, EDMONDS, WA, 98026, UNITED STATES
SALLY EDWARDS Governing Person 7315 - 212TH STREET SW, SUITE 101, EDMONDS, WA, 98026, UNITED STATES

National Provider Identifier

NPI Number:
1083643340

Authorized Person:

Name:
MS. MARCY SHIMADA
Role:
EXECUTIVE DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
4256703554

Form 5500 Series

Employer Identification Number (EIN):
911625339
Plan Year:
2009
Number Of Participants:
194
Sponsor's telephone number:
Plan Administrator / Signatory:
MARCY SHIMADA(Plan administrator)
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