WESTERN WASHINGTON MEDICAL GROUP, INC., P.S.

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Company Details

Legal Name:	WESTERN WASHINGTON MEDICAL GROUP, INC., P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	June 21st 1993
Expiration date:	30 Jun 2026
UBI Number:	601 474 013
ZIP code:	98201
City:	Everett
County:	SNOHOMISH
Home State:	WASHINGTON
Principal Office Street Address:	1728 W MARINE VIEW DR STE 110, EVERETT, WA, 98201-2094, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$3,323,560

Contact Details

E-Mail:

CORPORATE@OMWLAW.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role	Address
OMW R.A. SERVICES, LLC	Registered Agent	701 5TH AVE STE 5600, SEATTLE, WA, 98104-7045, UNITED STATES

Key Officers & Management

Name	Role
JEFF BOGGS, MD	Governing Person
EDUARDO CHUA, MD	Governing Person
MICHAEL DUONG, MD	Governing Person
CAROLYN FREED, ARNP	Governing Person
JUSTIN HAMPTON, PSYD	Governing Person
SETH HARTUNG	Governing Person
EMILY HUANG, MD	Governing Person
MAIYEN HAWKINS, MD	Governing Person
TYLER KENT, MD	Governing Person
DAVID LINDSTROM, MD	Governing Person

Unique Entity ID

Unique Entity ID:

PB86FRJXZ4T3

UEI Expiration Date:

2026-04-17

Business Information

Activation Date:

2025-04-21

Initial Registration Date:

2022-08-17

National Provider Identifier

NPI Number:

1427816305

Certification Date:

2024-03-06

Link:

View on NPI website

Authorized Person:

Name:

AMELIA EDENS

Role:

DIRECTOR OF PATIENT FINANCIAL SERVI

Phone:

4257404142

Taxonomy:

Selected Taxonomy:

207RI0200X - Infectious Disease Physician

Is Primary:

Yes

Contacts:

Phone:

+1 425-259-4041

Fax:

4257404155

Phone:

+1 425-252-1116

Form 5500 Series

Employer Identification Number (EIN):

911602128

Plan Year:

2021

Number Of Participants:

469

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

4252594041

File:

Plan Administrator / Signatory:

DAVID RUSSIAN, M.D.(Plan administrator)

Plan Year:

2020

Number Of Participants:

461

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

4252594041

File:

Plan Administrator / Signatory:

DAVID RUSSIAN, M.D.(Plan administrator)

Plan Year:

2019

Number Of Participants:

466

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

4252594041

File:

Plan Administrator / Signatory:

DAVID RUSSIAN, M.D.(Plan administrator)

Plan Year:

2018

Number Of Participants:

446

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

4252594041

File:

Plan Administrator / Signatory:

DAVID RUSSIAN, M.D.(Plan administrator)

Plan Year:

2017

Number Of Participants:

470

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

4252594041

File:

Plan Administrator / Signatory:

DAVID RUSSIAN, M.D.(Plan administrator)

Labor Condition Applications

Case Number:

I-201-24100-870582

Program:

H-1B1 Chile

Job Title:

Cardiology Practice Administrator

SOC (ONET/OES) code:

11-9111.00

SOC (ONET/OES) occupation title:

Medical and Health Services Managers

Begin Date:

2024-05-01

End Date:

2027-04-30

Employment and Wage Information

Address:

1728 W Marine View Drive, Suite 110, Everett, SNOHOMISH, WA, 98201

Wage Rate Paid to Nonimmigrant Workers:

$92,500.08

Per:

Year

Prevailing Wage Rate:

$92,352

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