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HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY LLC

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Company Details

Name: HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Inactive-Cancelled
Date of registration: 29 Dec 2009 (16 years ago)
Financial Date End: 31 Dec 2010
Branch of: HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY LLC, ALASKA (Company Number 125440)
Entity Number: 277595
Place of Formation: ALASKA
File Number: 277595
ZIP code: 83404
County: Bonneville County
Principal Address: 2085 PROVIDENCE WY IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1891025334

Authorized Person:

Name:
LINDSAY D SEWELL
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2085254885

Filing

Filing Name Filing Number Filing date
Cancellation 0000834199 2010-01-26
Initial Filing 0000277595 2009-12-29

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Date of last update: 27 Jun 2025

Sources: Idaho Secretary of State