0001937800-22-000001.txt : 20220712
0001937800-22-000001.hdr.sgml : 20220712
20220712172456
ACCESSION NUMBER: 0001937800-22-000001
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20220712
DATE AS OF CHANGE: 20220712
EFFECTIVENESS DATE: 20220712
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: PROVIDENCE MEDICAL GROUP, NORTHERN CALIFORNIA
CENTRAL INDEX KEY: 0001937800
IRS NUMBER: 881779768
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-452057
FILM NUMBER: 221079752
BUSINESS ADDRESS:
STREET 1: 185 SOTOYOME STREET
CITY: SANTA ROSA
STATE: CA
ZIP: 95405
BUSINESS PHONE: 707-387-3927
MAIL ADDRESS:
STREET 1: 185 SOTOYOME STREET
CITY: SANTA ROSA
STATE: CA
ZIP: 95405
D
1
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0001937800
PROVIDENCE MEDICAL GROUP, NORTHERN CALIFORNIA
185 SOTOYOME STREET
SANTA ROSA
CA
CALIFORNIA
95405
707-387-3927
CALIFORNIA
None
None
Corporation
true
2022
Jeannette
B.
Currie, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Director
Abhijit
Adhye, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Director
Gregory
Houghton, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Director
Mark
Pardoe, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Director
Leo
Leer, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Director
John
Aryanpur, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Executive Officer
Erik
McGoldrick, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Susana
Gonzalez, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Deborah
Britt, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Paul
Shen, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Daniel
Gilbert, D.O.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Avinash
Ramchandani, M.D.
185 Sotoyome Street
Santa Rosa
CA
CALIFORNIA
95405
Director
Hospitals and Physicians
Decline to Disclose
- 06b
false
2022-07-01
false
true
false
1500
246000
246000
0
false
164
0
0
0
false
PROVIDENCE MEDICAL GROUP, NORTHERN CALIFORNIA
Jeannette B. Currie, M.D.
Jeannette B. Currie, M.D.
President
2022-07-12