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LAKE CITY SHOE REPAIR

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Company Details

Name: LAKE CITY SHOE REPAIR
Jurisdiction: Idaho
Legal type: General Partnership (D)
Status: Active-Current
Date of registration: 20 Nov 2017 (8 years ago)
Expiration date: 04 Nov 2027
Entity Number: 10457
Place of Formation: IDAHO
File Number: 0000010457
ZIP code: 83815
County: Kootenai County
Principal Address: STE 7 3115 N GOVERNMENT WAY COEUR D ALENE, ID 83815-3700
Mailing Address: 3115 N GOVERNMENT WAY #7 COEUR D ALENE, ID 83815

Unique Entity ID

Unique Entity ID:
PD9PVA9QVGS5
CAGE Code:
748N7
UEI Expiration Date:
2026-01-29

Business Information

Activation Date:
2025-01-31
Initial Registration Date:
2014-05-02

Commercial and government entity program

CAGE number:
748N7
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2025-01-31
SAM Expiration:
2026-01-29

Contact Information

POC:
WAYNE C. JOHNSON

National Provider Identifier

NPI Number:
1346629029

Authorized Person:

Name:
WAYNE C JOHNSON
Role:
SENIOR PARTNOR
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
Yes

Contacts:

Fax:
2087620791

Filing

Filing Name Filing Number Filing date
Statement of Amendment of Partnership Authority (GP) 0004975196 2022-11-03
Initial Filing 0000010457 2017-11-20

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Date of last update: 22 Sep 2024

Sources: Idaho Secretary of State