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GEM STATE ENT, PLLC

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Company Details

Name: GEM STATE ENT, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 01 Jun 2010 (15 years ago)
Financial Date End: 30 Jun 2026
Entity Number: 290766
Place of Formation: IDAHO
File Number: 290766
ZIP code: 83301
County: Twin Falls County
Principal Address: PO BOX 1293 TWIN FALLS, ID 83303
Mailing Address: 2114 VILLAGE PARK AVE # 200 TWIN FALLS, ID 83301-4172

Agent

Name Role Address
JOHN A COLEMAN Agent 401 GOODING ST N STE 201, TWIN FALLS, ID 83301

Manager

Name Role Address Appointed On Resigned On
Russell Mayes Manager PO BOX 1293, TWIN FALLS, ID 83303 2021-05-19 No data
Kylan Peterson Manager PO BOX 1293, TWIN FALLS, ID 83303 2024-05-10 2024-05-10

U.S. Small Business Administration Profile

The U.S. Small Business Administration (SBA) helps Americans start, grow, and build resilient businesses.

Note: SBA was created in 1953 as an independent agency of the federal government to aid, counsel, assist and protect the interests of small business concerns; preserve free competitive enterprise; and maintain and strengthen the overall economy of our nation. SBA reviews Congressional and testifies on behalf of small businesses. It assesses the impact of regulatory burden on small businesses.

Phone Number:
E-mail Address:
Fax Number:
208-352-7333
Contact Person:
ALI MOORE
User ID:
P3311662

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
XWJSNJBQU898
CAGE Code:
9ZM36
UEI Expiration Date:
2025-08-16

Business Information

Division Name:
GEM STATE ENT AND HEARING PROFESSIONALS
Activation Date:
2024-08-21
Initial Registration Date:
2024-08-02

National Provider Identifier

NPI Number:
1215715669
Certification Date:
2025-04-08

Authorized Person:

Name:
BROOKE FREIDENBERGER
Role:
MEDICAL CODER
Phone:

Taxonomy:

Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

Fax:
2088041707
Fax:
2083527333

Filing

Filing Name Filing Number Filing date
Annual Report 0006247625 2025-05-09
Statement of Change of Business Mailing Address 0005862920 2024-08-15
Annual Report 0005734289 2024-05-10
Annual Report 0005221886 2023-05-03
Annual Report 0004767865 2022-06-03

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Date of last update: 31 May 2025

Sources: Idaho Secretary of State