0001779461-21-000001.txt : 20210315 0001779461-21-000001.hdr.sgml : 20210315 20210312180456 ACCESSION NUMBER: 0001779461-21-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210315 DATE AS OF CHANGE: 20210312 EFFECTIVENESS DATE: 20210315 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: 21739078 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 DALE GROSS 4450 SOUTHPARK BLUFF DRIVE ANCHORAGE AK ALASKA 99516 Executive Officer Director JILL KLEIN 2006 PARKVIEW CIR ANCHORAGE AK ALASKA 99501 Executive Officer Director PETER LUNOE 8440 ELMORE ROAD ANCHORAGE AK ALASKA 99507 Executive Officer Director STEVEN ROSENFIELD 9430 SUGAR CIRCLE ANCHORAGE AK ALASKA 99507 Executive Officer Director STEVEN SIVILS 2530 BRANDY CIRCLE ANCHORAGE AK ALASKA 99513 Executive Officer Director Hospitals and Physicians Decline to Disclose 06b true 0001779461-20-000001 2019-06-29 true true false 5000 25000 15000 10000 false 3 0 0 0 false PROVIDENCE ANCHORAGE ANESTHESIA MEDICAL GROUP, P.C. /s/ Dale Gross Dale Gross President 2021-03-12