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TIMBERLAKE FAMILY MEDICINE PLLC

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Company Details

Name: TIMBERLAKE FAMILY MEDICINE PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 02 Jul 2007 (18 years ago)
Financial Date End: 31 Jul 2008
Date dissolved: 07 Oct 2008
Entity Number: 203687
Place of Formation: IDAHO
File Number: 0000203687
ZIP code: 83801
County: Kootenai County
Principal Address: 6101 W HWY 54 STE A PO BOX 775 ATHOL, ID 83801

National Provider Identifier

NPI Number:
1932392933

Authorized Person:

Name:
MR. CHRISTOPHER RAY SUNDQUIST
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2086830900

Filing

Filing Name Filing Number Filing date
Initial Filing 0000203687 2007-07-02

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State