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INLAND NORTHWEST SPINE, PLLC

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Company Details

Name: INLAND NORTHWEST SPINE, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 26 Jul 2006 (19 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 170366
Place of Formation: IDAHO
File Number: 170366
ZIP code: 83814
County: Kootenai County
Principal Address: D BLATY STE 300 850 W IRONWOOD DR COEUR D ALENE, ID 83814-4903

Agent

Name Role Address
Kellie Carter Agent 850 W IRONWOOD DRIVE, 300, COEUR D ALENE, ID 83814

Manager

Name Role Address Appointed On Resigned On
Bret A Dirks Manager 850 W IRONWOOD DRIVE, COEUR D ALENE, ID 83814 2021-06-03 2021-12-27
DOUG BLATY Manager 850 W IRONWOOD DR, COEUR D ALENE, ID 83814 2022-04-14 No data

Governor

Name Role Address Appointed On Resigned On
DOUG BLATY Governor 850 W IRONWOOD DR, COEUR D ALENE, ID 83814 2021-12-27 2022-04-14

Member

Name Role Address Appointed On
Tanya S Blaty Member 2541 N VIKING LOOP, POST FALLS, ID 83854 2024-06-04

National Provider Identifier

NPI Number:
1700974714
Certification Date:
2022-06-01

Authorized Person:

Name:
DOUGLAS BLATY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207T00000X - Neurological Surgery Physician
Is Primary:
No
Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2082920873

Filing

Filing Name Filing Number Filing date
Annual Report 0005760424 2024-06-04
Annual Report 0005265297 2023-06-05
Annual Report 0004845985 2022-08-04
Amendment to Certificate 0004697845 2022-04-14
Amendment to Certificate 0004555840 2021-12-27

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Date of last update: 28 May 2025

Sources: Idaho Secretary of State