| LCA CASE NUMBER | I-200-22047-907619 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2022-02-16 |
| DECISION DATE | 2022-02-24 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Physician – Family Practice |
| SOC CODE | 29-1063.00 |
| SOC TITLE | Internists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2022-06-01 |
| END DATE | 2025-05-31 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Providence Health & Services - Oregon |
| TRADE NAME DBA | Providence Medical Group |
| EMPLOYER ADDRESS1 | 4400 NE HALSEY STREET |
| EMPLOYER CITY | Portland |
| EMPLOYER STATE | OR |
| EMPLOYER POSTAL CODE | 97213 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 14256156359 |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Jeanes |
| EMPLOYER POC FIRST NAME | Maria |
| EMPLOYER POC MIDDLE NAME | Salazar |
| EMPLOYER POC JOB TITLE | Immigration Program Manager |
| EMPLOYER POC ADDRESS1 | 1801 Lind Ave SW |
| EMPLOYER POC ADDRESS2 | Morin Building 1st Floor |
| EMPLOYER POC CITY | Renton |
| EMPLOYER POC STATE | WA |
| EMPLOYER POC POSTAL CODE | 98057 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 14256156359 |
| EMPLOYER POC EMAIL | maria.jeanes@providence.org |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Vo |
| AGENT ATTORNEY FIRST NAME | Betsy |
| AGENT ATTORNEY MIDDLE NAME | M. |
| AGENT ATTORNEY ADDRESS1 | 1801 Lind Ave SW |
| AGENT ATTORNEY ADDRESS2 | Morin Building 1st Floor |
| AGENT ATTORNEY CITY | Renton |
| AGENT ATTORNEY STATE | WA |
| AGENT ATTORNEY POSTAL CODE | 98057 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 14259439907 |
| AGENT ATTORNEY EMAIL ADDRESS | betsy.vo@providence.org |
| LAWFIRM NAME BUSINESS NAME | Providence Health & Services |
| STATE OF HIGHEST COURT | WA |
| NAME OF HIGHEST STATE COURT | WASHINGTON STATE SUPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 440 NW Division |
| WORKSITE ADDRESS2 | Providence Medical Group Gresham |
| LCA CASE WORKLOC1 CITY | Gresham |
| WORKSITE COUNTY | MULTNOMAH |
| LCA CASE WORKLOC1 STATE | OR |
| WORKSITE POSTAL CODE | 97030 |
| LCA CASE WAGE RATE FROM | 208000 |
| LCA CASE WAGE RATE TO | 215000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 208000 |
| PW UNIT OF PAY | Year |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Vo |
| PREPARER FIRST NAME | Betsy |
| PREPARER MIDDLE INITIAL | M |
| PREPARER BUSINESS NAME | Providence Health & Services |
| PREPARER EMAIL | betsy.vo@providence.org |
