TRI-CITY EAR, NOSE & THROAT, P.S.

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Company Details

Legal Name:	TRI-CITY EAR, NOSE & THROAT, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	December 31st 1998
Date of Dissolution:	May 1st 2017
Expiration date:	31 Dec 2016
UBI Number:	601 922 510

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Registered Agent Information

Name	Role	Address
SHELLEY THIEL MD	Registered Agent	911 S WASHINGTON STE A, KENNEWICK, WA, 99336-0000, UNITED STATES

Key Officers & Management

Name	Role	Address
SHELLEY THIEL	Governing Person	10018 W COURT ST, PASCO, WA, 99301-6591, UNITED STATES

National Provider Identifier

NPI Number:

1689612046

Link:

View on NPI website

Authorized Person:

Name:

RINDI J BAZE

Role:

PRACTICE MANAGER

Phone:

5095868368

Taxonomy:

Selected Taxonomy:

231H00000X - Audiologist

Is Primary:

No

Selected Taxonomy:

207Y00000X - Otolaryngology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 509-586-8368

Fax:

5095862525

Form 5500 Series

Employer Identification Number (EIN):

911948319

Plan Year:

2015

Number Of Participants:

2

Sponsor's telephone number:

5095868368

File:

Plan Year:

2014

Number Of Participants:

6

Sponsor's telephone number:

5095868368

File:

Plan Year:

2014

Number Of Participants:

8

Sponsor's telephone number:

5095868368

Plan Administrator / Signatory:

LAURIE HARMON, AS PRACTITIONER(Plan administrator)

Plan Year:

2013

Number Of Participants:

8

Sponsor's telephone number:

5095868368

File:

Plan Administrator / Signatory:

LAURIE HARMON, AS PRACTITIONER(Plan administrator)

Plan Year:

2012

Number Of Participants:

10

Sponsor's telephone number:

5095868368

File:

Plan Administrator / Signatory:

SHELLEY THIEL(Plan administrator)

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