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LIFE SPRING WOMEN'S CLINIC, P.A.

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Company Details

Name: LIFE SPRING WOMEN'S CLINIC, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 10 Jul 1991 (34 years ago)
Financial Date End: 31 Jul 2018
Date dissolved: 03 Dec 2018
Entity Number: 296758
Place of Formation: IDAHO
File Number: 0000296758
ZIP code: 83401
County: Bonneville County
Mailing Address: 1660 JOHN ADAMS PARKWAY IDAHO FALLS, ID 83401

Agent

Name Role Address
CRAIG Z. HALL Agent 1660 JOHN ADAMS PARKWAY, IDAHO FALLS, ID 83401

National Provider Identifier

NPI Number:
1265635346

Authorized Person:

Name:
CRAIG Z. HALL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
820445619
Plan Year:
2016
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
9
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003357830 2018-12-03
Annual Report 0002210636 2017-05-25
Annual Report 0002210635 2016-05-23
Annual Report 0002210633 2015-05-19
Annual Report 0002210631 2014-05-12

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State