0001779461-19-000001.txt : 20190614 0001779461-19-000001.hdr.sgml : 20190614 20190614140305 ACCESSION NUMBER: 0001779461-19-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190614 DATE AS OF CHANGE: 20190614 EFFECTIVENESS DATE: 20190614 FILER: COMPANY DATA: COMPANY CONFORMED NAME: PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C. CENTRAL INDEX KEY: 0001779461 IRS NUMBER: 920142958 STATE OF INCORPORATION: AK FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-341980 FILM NUMBER: 19898440 BUSINESS ADDRESS: STREET 1: 3300 PROVIDENCE DRIVE, SUITE 207 CITY: ANCHORAGE STATE: AK ZIP: 99508 BUSINESS PHONE: (907) 561-0027 MAIL ADDRESS: STREET 1: 3300 PROVIDENCE DRIVE, SUITE 207 CITY: ANCHORAGE STATE: AK ZIP: 99508 D 1 primary_doc.xml X0708 D LIVE 0001779461 PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C. 3300 PROVIDENCE DRIVE, SUITE 207 ANCHORAGE AK ALASKA 99508 (907) 561-0027 ALASKA None None Corporation true LEIF LUNOE 8540 CORMORANT COVE CIRCLE ANCHORAGE AK ALASKA 99507 Executive Officer Director DALE GROSS 4450 SOUTHPARK BLUFF DRIVE ANCHORAGE AK ALASKA 99516 Executive Officer Director LINDSAY COBB 8934 CLARIDGE PLACE ANCHORAGE AK ALASKA 99507 Executive Officer Director KIRSTEN RANDALL 2440 E. TUDOR ROAD, #237 ANCHORAGE AK ALASKA 99507 Executive Officer Director TRAVIS BOND 10700 KASILOF BLVD. ANCHORAGE AK ALASKA 99507 Executive Officer Director JAMES H. BROOKS 3300 PROVIDENCE DRIVE, SUITE 207 ANCHORAGE AK ALASKA 99508 Executive Officer Hospitals and Physicians Decline to Disclose 06b false true false true false 5000 10000 0 10000 false 0 0 0 0 false PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C. /s/ Leif Lunoe, M.D. Leif Lunoe, M.D. President 2019-06-14