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SOUTHLAKE CLINIC, INC. P.S.

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Company Details

Legal Name: SOUTHLAKE CLINIC, INC. P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: October 6th 1971
Date of Dissolution: January 2nd 2019
Expiration date: 31 Oct 2018
UBI Number: 600 052 154

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Registered Agent Information

Name Role Address
WILLIAM PARK Registered Agent 4011 TALBOT RD S STE 500, RENTON, WA, 98055-0000, UNITED STATES

Key Officers & Management

Name Role
FRANK THOMAS Governing Person
WILLIAM PARK Governing Person
RAJIB CHOUDHURY Governing Person

National Provider Identifier

NPI Number:
1538394234

Authorized Person:

Name:
MS. MARIANNE LARSON
Role:
COO
Phone:

Taxonomy:

Selected Taxonomy:
207ZP0101X - Anatomic Pathology Physician
Is Primary:
Yes

Contacts:

Fax:
4257937458
Fax:
4257934710
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