UROLOGY NORTHWEST, P.S.

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Company Details

Legal Name:	UROLOGY NORTHWEST, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	June 1st 1995
Date of Dissolution:	November 3rd 2018
Expiration date:	30 Jun 2018
UBI Number:	601 634 199
ZIP code:	98043
City:	Mountlake Terrace
County:	SNOHOMISH
Home State:	WASHINGTON
Principal Office Street Address:	6005 244TH ST SW # 111, MOUNTLAKE TERRACE, WA, 98043, UNITED STATES

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Registered Agent Information

Name	Role	Address
KARNY JACOBY	Registered Agent	6005 244TH ST SW STE 111, MOUNTLAKE TERRACE, WA, 98043-5400, UNITED STATES

Key Officers & Management

Name	Role	Address
JAMES DOWNEY	Governing Person	6005 244TH ST SW # 111, MOUNTLAKE TERRACE, WA, 98043, UNITED STATES
KARNY JACOBY	Governing Person	6005 244TH ST SW # 111, MOUNTLAKE TERRACE, WA, 98043, UNITED STATES
SUSAN WALTERS	Governing Person	6005 244TH ST SW # 111, MOUNTLAKE TERRACE, WA, 98043, UNITED STATES

National Provider Identifier

NPI Number:

1124084983

Link:

View on NPI website

Authorized Person:

Name:

CANDY S CHAPMAN

Role:

ADMINISTRATOR

Phone:

4252755547

Taxonomy:

Selected Taxonomy:

208800000X - Urology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 425-275-5555

Fax:

4252755591

Form 5500 Series

Employer Identification Number (EIN):

911685391

Plan Year:

2017

Number Of Participants:

35

Plan Name:

401(K)

Sponsor's telephone number:

4252755555

File:

Plan Year:

2017

Number Of Participants:

29

Plan Name:

401(K)

Sponsor's telephone number:

4252755555

File:

Plan Year:

2016

Number Of Participants:

38

Plan Name:

401(K)

Sponsor's telephone number:

4252755555

File:

Plan Year:

2015

Number Of Participants:

39

Plan Name:

401(K)

Sponsor's telephone number:

4252755555

File:

Plan Year:

2014

Number Of Participants:

44

Plan Name:

401(K)

Sponsor's telephone number:

4252755555

File:

Plan Administrator / Signatory:

KARNY JACOBY, M.D.(Plan administrator)

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