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PEDIATRIC CARDIOLOGY OF IDAHO

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Company Details

Name: PEDIATRIC CARDIOLOGY OF IDAHO
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 07 Dec 2000 (25 years ago)
Entity Number: 135352
Place of Formation: IDAHO
File Number: 0000135352
ZIP code: 83712
County: Ada County
Mailing Address: 100 WARM SPRINGS AVE STE D BOISE, ID 83712

National Provider Identifier

NPI Number:
1376362038
Certification Date:
2024-10-08

Authorized Person:

Name:
WHITNEY BAIRD
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
2080P0202X - Pediatric Cardiology Physician
Is Primary:
Yes

Contacts:

Fax:
2084539963

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000736987 2011-10-24
Initial Filing 0000135352 2000-12-07

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State