0001779461-20-000001.txt : 20200930 0001779461-20-000001.hdr.sgml : 20200930 20200929180147 ACCESSION NUMBER: 0001779461-20-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20200930 DATE AS OF CHANGE: 20200929 EFFECTIVENESS DATE: 20200930 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/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-341980 FILM NUMBER: 201209978 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/A 1 primary_doc.xml X0708 D/A 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 10330 SIDOROF LANE ANCHORAGE AK ALASKA 99507 Executive Officer Director DALE GROSS 4450 SOUTHPARK BLUFF DRIVE ANCHORAGE AK ALASKA 99516 Executive Officer Director TRAVIS BOND 10700 KASILOF BLVD. ANCHORAGE AK ALASKA 99507 Executive Officer Director JILL KLEIN 2006 PARKVIEW CIR ANCHORAGE AK ALASKA 99501 Executive Officer Director NATHANIEL SMITH 12020 GINAMI ST ANCHORAGE AK ALASKA 99516 Executive Officer Director Hospitals and Physicians Decline to Disclose 06b true 0001779461-19-000001 2019-06-29 true true false 5000 15000 10000 5000 false 2 0 0 0 false PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C. /s/ Leif Lunoe, M.D. Leif Lunoe, M.D. President 2020-09-29