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PUYALLUP REGENERATIVE MEDICINE, PLLC

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Company Details

Legal Name: PUYALLUP REGENERATIVE MEDICINE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: April 10th 2018
Date of Dissolution: September 3rd 2023
Expiration date: 30 Apr 2023
UBI Number: 604 269 403
ZIP code: 98390
City: Sumner
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 15901 WASHINGTON ST E, SUMNER, WA, 98390-3111, UNITED STATES
Principal Office Mailing Address: Google Maps Logo PO BOX 1272, SUMNER, WA, 98390-0250, UNITED STATES

Contact Details

E-Mail: HSPUYALLUP@GMAIL.COM
Phone Number: +1 253-332-3628

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
MICHAEL CHURCH Registered Agent 15901 WASHINGTON ST E, SUMNER, WA, 98390-3111, UNITED STATES

Key Officers & Management

Name Role Address
MICHAEL CHURCH Executor 15901 WASHINGTON ST E, PO BOX 1272, SUMNER, WA, 98390-3111, UNITED STATES
MICHAEL CHURCH Governing Person 1703 S MERIDIAN STE 301, PUYALLUP, WA, 98371-7590, UNITED STATES

National Provider Identifier

NPI Number:
1740872944
Certification Date:
2021-04-28

Authorized Person:

Name:
DR. MICHAEL LEE CHURCH
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

Fax:
2534455712
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