0001791687-19-000001.txt : 20191021 0001791687-19-000001.hdr.sgml : 20191021 20191021113925 ACCESSION NUMBER: 0001791687-19-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 504(b)(1) (not (i), (ii) or (iii)) ITEM INFORMATION: 06b FILED AS OF DATE: 20191021 DATE AS OF CHANGE: 20191021 EFFECTIVENESS DATE: 20191021 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Physician 360, Inc. CENTRAL INDEX KEY: 0001791687 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-351471 FILM NUMBER: 191159127 BUSINESS ADDRESS: STREET 1: 300 STATE STREET STREET 2: UNIT 92202 CITY: SOUTHLAKE STATE: TX ZIP: 76092 BUSINESS PHONE: 360-861-6199 MAIL ADDRESS: STREET 1: 300 STATE STREET STREET 2: UNIT 92202 CITY: SOUTHLAKE STATE: TX ZIP: 76092 D 1 primary_doc.xml X0708 D LIVE 0001791687 Physician 360, Inc. 300 STATE STREET UNIT 92202 SOUTHLAKE TX TEXAS 76092 360-861-6199 DELAWARE None None Corporation true 2016 Angela Fusaro 300 State Street Unit 92202 Southlake TX TEXAS 76092 Executive Officer Director Robert Lapporte 300 State Street Unit 92202 Southlake TX TEXAS 76092 Executive Officer Director Other Health Care Decline to Disclose 04 06b false 2019-09-30 false true false 10000 500000 400000 100000 false 1 0 0 0 false Physician 360, Inc. Angela Fusaro Angela Fusaro Chief Executive Officer 2019-10-21