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POCATELLO CHILDREN'S CLINIC

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Company Details

Name: POCATELLO CHILDREN'S CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 04 Apr 2005 (20 years ago)
Entity Number: 268727
Place of Formation: IDAHO
File Number: 0000268727
Mailing Address: JESSICA PERRY 1151 HOSPITAL WAY BLDG F POCATELLO, ID 83201-5091

National Provider Identifier

NPI Number:
1023287828

Authorized Person:

Name:
MS. JESSICA PERRY
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
Yes

Contacts:

Fax:
2082393434

Filing

Filing Name Filing Number Filing date
Amendment of Mailing Address for Certificate of Assumed Business Name 0003365403 2018-12-07
Initial Filing 0000268727 2005-04-04

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State