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LAKE CITY SURGEONS, PLLC

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Company Details

Name: LAKE CITY SURGEONS, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 20 Dec 2004 (21 years ago)
Financial Date End: 31 Dec 2013
Date dissolved: 10 Mar 2014
Entity Number: 118391
Place of Formation: IDAHO
File Number: 0000118391
ZIP code: 83814
County: Kootenai County
Principal Address: 608 NW BLVD STE 301 COEUR D ALENE, ID 83814

National Provider Identifier

NPI Number:
1659483410

Authorized Person:

Name:
LISA D WHITE
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2086645345

Form 5500 Series

Employer Identification Number (EIN):
202108756
Plan Year:
2009
Number Of Participants:
9
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0001370233 2012-10-26
Annual Report 0001370232 2012-01-10
Annual Report 0001370231 2011-02-11
Annual Report 0001370230 2009-10-22
Annual Report 0001370235 2008-10-20

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State