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AUSTIN R. CUSHMAN, M.D., P.A.

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Company Details

Name: AUSTIN R. CUSHMAN, M.D., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 31 Dec 1992 (33 years ago)
Financial Date End: 31 Dec 2018
Date dissolved: 16 Apr 2019
Entity Number: 311050
Place of Formation: IDAHO
File Number: 0000311050
ZIP code: 83706
County: Ada County
Mailing Address: 1366 E RIVER RUN DR BOISE, ID 83706

Agent

Name Role Address
AUSTIN R. CUSHMAN M.D. Agent A.R., BOISE, ID 83706

National Provider Identifier

NPI Number:
1851620520

Authorized Person:

Name:
DR. AUSTIN R CUSHMAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2083672673

Form 5500 Series

Employer Identification Number (EIN):
820455447
Plan Year:
2011
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
3
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003480949 2019-04-16
Annual Report 0002290242 2018-03-05
Annual Report 0002290239 2016-10-31
Annual Report 0002290238 2016-02-23
Annual Report 0002290235 2014-11-17

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State