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BOISE ANESTHESIA, P.A.

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Company Details

Name: BOISE ANESTHESIA, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 29 Dec 1988 (36 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 274616
Place of Formation: IDAHO
File Number: 274616
ZIP code: 83706
County: Ada County
Mailing Address: 1055 N CURTIS ROAD BOISE, ID 83706

Agent

Name Role Address
JOSEPH H UBERUAGA II Agent 1111 W JEFFERSON SUITE 530, BOISE, ID 83702

President

Name Role Address Appointed On Resigned On
JOHN MARTIN President 1055 N CURTIS RD, BOISE, ID 83706 2021-03-22 2022-12-21
John Martin President 150 W CIVIC CENTER DR, SANDY, UT 84070-4284 2024-11-21 No data

National Provider Identifier

NPI Number:
1487602298
Certification Date:
2022-01-14

Authorized Person:

Name:
MATTHEW BRYAN FOWLER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
367500000X - Certified Registered Nurse Anesthetist
Is Primary:
No
Selected Taxonomy:
207L00000X - Anesthesiology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
820425454
Plan Year:
2019
Number Of Participants:
83
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
96
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
85
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
80
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
1
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005991014 2024-11-21
Application for Reinstatement 0005751047 2024-05-30
Dissolution/Revocation - Administrative 0005649939 2024-03-15
Annual Report 0005035911 2022-12-21
Annual Report 0004571994 2022-01-14

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Date of last update: 31 May 2025

Sources: Idaho Secretary of State