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FAMILY PRACTICE RESIDENCY OF IDAHO, INC.

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Company Details

Name: FAMILY PRACTICE RESIDENCY OF IDAHO, INC.
Jurisdiction: Idaho
Legal type: Non-Profit Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 23 May 1975 (50 years ago)
Financial Date End: 31 May 2020
Date dissolved: 05 Aug 2020
Entity Number: 165923
Place of Formation: IDAHO
File Number: 165923
ZIP code: 83704
County: Ada County
Mailing Address: 777 N RAYMOND ST BOISE, ID 83704-9251

Agent

Name Role Address
TED EPPERLY MD Agent 777 NORTH RAYMOND, BOISE, ID 83704

National Provider Identifier

NPI Number:
1982632550

Authorized Person:

Name:
TED EPPERLY
Role:
CHAIRMAN AND PROGRAM DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083676123

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003959153 2020-08-05
Annual Report 0003497187 2019-04-29
Annual Report 0001573386 2018-06-18
Annual Report 0001573384 2017-05-22
Annual Report 0001573382 2016-05-31

USAspending Awards / Financial Assistance

Date:
2009-07-20
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
RESIDENCY TRAINING IN PRIMARY CARE
Obligated Amount:
372060.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2008-01-23
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
OP EARLY INTERVENTION SERVICES WITH RESPECT TO HIV DISEASE
Obligated Amount:
8463601.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

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Date of last update: 28 May 2025

Sources: Idaho Secretary of State