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BOISE OBSTETRIC & GYNECOLOGIC ASSOCIATES, PA

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Company Details

Name: BOISE OBSTETRIC & GYNECOLOGIC ASSOCIATES, PA
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 25 Jun 1973 (52 years ago)
Financial Date End: 30 Jun 2013
Date dissolved: 10 Sep 2013
Entity Number: 154869
Place of Formation: IDAHO
File Number: 0000154869
ZIP code: 83706
County: Ada County
Mailing Address: 5966 CURTISIAN BOISE, ID 83706

National Provider Identifier

NPI Number:
1487693032

Authorized Person:

Name:
CHERYL R GLEASON
Role:
CLINIC ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
367A00000X - Advanced Practice Midwife
Is Primary:
No
Selected Taxonomy:
207V00000X - Obstetrics & Gynecology Physician
Is Primary:
Yes

Contacts:

Fax:
2083732643

Filing

Filing Name Filing Number Filing date
Annual Report 0001524466 2012-06-05
Annual Report 0001524462 2011-06-02
Annual Report 0001524461 2010-05-17
Annual Report 0001524460 2009-04-13
Annual Report 0001524464 2008-05-23

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State