| Name: | Moose Creek Medical Clinic, LLC |
| Jurisdiction: | Alaska |
| Legal type: | Limited Liability Company |
| Status: | Non-Compliant |
| Date of registration: | 06 Feb 2018 (7 years ago) |
| Entity Number: | 10077634 |
| ZIP code: | 99654 |
| County: | Matanuska Susitna |
| Place of Formation: | ALASKA |
| Address: | 211 E FAIRVIEW LP, WASILLA, AK 99654 |
| Mailing Address: | 1808 W JAIME MARIE CIR, WASILLA, AK 99654 |
Line of Business
62 Health Care and Social AssistanceNAICS
621399 OFFICES OF ALL OTHER MISCELLANEOUS HEALTH PRACTITIONERS| Name | Role |
|---|---|
| Kymberli Brock | Member |
| Chipper Brock | Manager |
| Chipper Brock | Member |
| McKinley Brock | Member |
| United States Corporation Agents, Inc. | Registered Agent |
| Kymberli Brock | Manager |
| Plan Name | Plan Year | EIN/PN | Received | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MOOSE CREEK MEDICAL CLINIC LLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 824424694 | 2024-07-09 | 13 | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-07-09 |
| Name of individual signing | CHIPPER J BROCK |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Sponsor | MOOSE CREEK MEDICAL CLINIC LLC |
| Business code | 541990 |
| Sponsor’s telephone number | 9076319149 |
| Plan sponsor’s address | 1808 W JAIME MARIE CIRCLE, WASILLA, AK, 99654 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-26 |
| Name of individual signing | CHIPPER BROCK |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Sponsor | MOOSE CREEK MEDICAL CLINIC LLC |
| Business code | 541990 |
| Sponsor’s telephone number | 9076319149 |
| Plan sponsor’s address | 1808 W JAIME MARIE CIRCLE, WASILLA, AK, 99654 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-25 |
| Name of individual signing | CHIPPER BROCK |
| Type | License Number | Status | Date of issue | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| Business License | 1069767 | Active | 2018-03-13 | 2023-10-13 | 2025-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 621399 - OFFICES OF ALL OTHER MISCELLANEOUS HEALTH PRACTITIONERS |
| Telemedicine Business Registry | 159704 | Active | 2020-03-26 | - | - | - |
Date of last update: 26 Aug 2024
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
