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NORTH IDAHO PAIN CENTER, LLC

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Company Details

Name: NORTH IDAHO PAIN CENTER, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 01 Sep 2005 (20 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 139713
Place of Formation: IDAHO
File Number: 139713
ZIP code: 83814
County: Kootenai County
Principal Address: 1686 W. RIVERSTONE DR. #2 COEUR D ALENE, ID 83814
Mailing Address: 1686 W RIVERSTONE DR # 2 COEUR D ALENE, ID 83814-5779

Agent

Name Role Address
SCOTT K MAGNUSON MD Agent 1686 W. RIVERSTONE DR. #2, COEUR D'ALENE, ID 83814

Manager

Name Role Address Appointed On
Michele Magnuson Manager 1686 W RIVERSTONE DR, COEUR D ALENE, ID 83814-5779 2020-09-09

National Provider Identifier

NPI Number:
1104896422
Certification Date:
2023-03-14

Authorized Person:

Name:
MS. JENNIFER SEXTON
Role:
BILLING
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2087652903

Filing

Filing Name Filing Number Filing date
Annual Report 0005863052 2024-08-15
Annual Report 0005385628 2023-09-06
Annual Report 0004855546 2022-08-10
Annual Report 0004369921 2021-08-04
Annual Report 0004000116 2020-09-09

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Date of last update: 27 May 2025

Sources: Idaho Secretary of State