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FRUITLAND ORTHOPEDIC CLINIC

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Company Details

Name: FRUITLAND ORTHOPEDIC CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 07 Jul 2004 (21 years ago)
Entity Number: 244032
Place of Formation: IDAHO
File Number: 0000244032
ZIP code: 83619
County: Payette County
Mailing Address: 1118 N W 16TH ST STE C FRUITLAND, ID 83619

National Provider Identifier

NPI Number:
1710975057

Authorized Person:

Name:
JAN OLOF DAHLIN
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
2084522513

Filing

Filing Name Filing Number Filing date
Initial Filing 0000244032 2004-07-07

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State