SEATTLE SPORTS & REGENERATIVE MEDICINE, PLLC

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Company Details

Legal Name:	SEATTLE SPORTS & REGENERATIVE MEDICINE, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	May 18th 2017
Expiration date:	31 May 2026
UBI Number:	604 126 598
ZIP code:	98109
City:	Seattle
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	1000 DEXTER AVE N STE 320, SEATTLE, WA, 98109-4878, UNITED STATES
Principal Office Mailing Address:	1000 DEXTER AVE N STE 320, STE 320, SEATTLE, WA, 98109-4878, UNITED STATES

Contact Details

E-Mail:	MWAGNER@SEATTLESPORTSCLINIC.COM
Phone Number:	+1 206-620-0333

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
MARK WAGNER, MD	Registered Agent	1000 DEXTER AVE N STE 320, SEATTLE, WA, 98109-4878, UNITED STATES

Key Officers & Management

Name	Role
MARK WAGNER	Governing Person
DR MARK WAGNER	Governing Person

National Provider Identifier

NPI Number:

1871020933

Certification Date:

2021-10-07

Link:

View on NPI website

Authorized Person:

Name:

MARK D WAGNER

Role:

OWNER

Phone:

2069998556

Taxonomy:

Selected Taxonomy:

207Q00000X - Family Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 206-486-7837

Fax:

2064627520

Phone:

+1 206-999-8556

Form 5500 Series

Employer Identification Number (EIN):

821576796

Plan Year:

2023

Number Of Participants:

8

Plan Name:

CASH BALANCE

Sponsor's telephone number:

2066200333

File:

Plan Year:

2023

Number Of Participants:

10

Plan Name:

401(K)

Sponsor's telephone number:

2066200333

File:

Plan Year:

2022

Number Of Participants:

8

Plan Name:

401(K)

Sponsor's telephone number:

2066200333

File:

Plan Year:

2022

Number Of Participants:

5

Plan Name:

CASH BALANCE

Sponsor's telephone number:

2066200333

File:

Plan Year:

2021

Number Of Participants:

9

Plan Name:

401(K)

Sponsor's telephone number:

2066200333

File:

History

Type	Old value	New value	Date of change
Name change	SEATTLE SPORTS & REGENERATIVE MEDICINE, LLC	SEATTLE SPORTS & REGENERATIVE MEDICINE, PLLC	2021-08-13

Paycheck Protection Program

Jobs Reported:

6

Initial Approval Amount:

$95,600

Date Approved:

2020-04-12

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$95,600

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$96,579.57

Servicing Lender:

KeyBank National Association

Use of Proceeds:

Payroll: $95,600

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