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TREASURE VALLEY COLON & RECTAL CLINIC, PLLC

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Company Details

Name: TREASURE VALLEY COLON & RECTAL CLINIC, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 20 Jan 2011 (14 years ago)
Financial Date End: 31 Jan 2025
Date dissolved: 28 Dec 2023
Entity Number: 308631
Place of Formation: IDAHO
File Number: 308631
ZIP code: 83616
County: Ada County
Principal Address: PO BOX 2685 EAGLE, ID 83616
Mailing Address: PO BOX 2685 EAGLE, ID 83616-9122

Agent

Name Role Address
WM F GIGRAY III Agent 5700 E FRANKLIN RD STE 200, NAMPA, ID 83687

Member

Name Role Address Appointed On
Johnny B Green MD Member PO BOX 2685, EAGLE, ID 83616 2021-01-12

National Provider Identifier

NPI Number:
1316243371

Authorized Person:

Name:
DR. JOHNNY B GREEN
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
No
Selected Taxonomy:
208C00000X - Colon & Rectal Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2083673059

Filing

Filing Name Filing Number Filing date
Annual Report 0005529397 2023-12-28
Statement of Dissolution 0005529422 2023-12-28
Annual Report 0005046403 2023-01-03
Annual Report 0004544485 2021-12-29
Annual Report 0004132527 2021-01-12

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Date of last update: 01 Jun 2025

Sources: Idaho Secretary of State