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IDAHO DIABETES AND ENDOCRINE ASSOCIATES, P.A.

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Company Details

Name: IDAHO DIABETES AND ENDOCRINE ASSOCIATES, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 01 Feb 1993 (33 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 312065
Place of Formation: IDAHO
File Number: 312065
ZIP code: 83616
County: Ada County
Mailing Address: NICOLE ROBERTS 6063 W HAMM CT EAGLE, ID 83616

Agent

Name Role Address
THEODORE S ROOSEVELT Agent 13909 W WAINWRIGHT DR, BOISE, ID 83713

President

Name Role Address Appointed On
Theodore S Roosevelt President 6063 W HAMM CT, EAGLE, ID 83616 2021-01-03

Treasurer

Name Role Address Appointed On Resigned On
BEVERLY J ROOSEVELT Treasurer 13909 W WAINWRIGHT DR, BOISE, ID 83713 2024-01-05 2024-01-05

Secretary

Name Role Address Appointed On Resigned On
NICOLE L ROBERTS Secretary 13909 W WAINWRIGHT DR, BOISE, ID 83713 2024-01-05 2024-01-05

National Provider Identifier

NPI Number:
1790960961
Certification Date:
2022-05-18

Authorized Person:

Name:
DR. THEODORE S ROOSEVELT
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
No
Selected Taxonomy:
207RE0101X - Endocrinology, Diabetes & Metabolism Physician
Is Primary:
Yes

Contacts:

Fax:
2083894659

Filing

Filing Name Filing Number Filing date
Annual Report 0006091197 2025-02-03
Annual Report 0005544169 2024-01-05
Annual Report 0005077531 2023-01-22
Annual Report 0004661664 2022-03-15
Annual Report 0004113694 2021-01-03

USAspending Awards / Financial Assistance

Date:
2020-05-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
46075.00
Total Face Value Of Loan:
46075.00

Paycheck Protection Program

Jobs Reported:
6
Initial Approval Amount:
$46,075
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$46,075
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$46,486.52
Servicing Lender:
Bank of America, National Association
Use of Proceeds:
Payroll: $46,075

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Date of last update: 05 Aug 2025

Sources: Idaho Secretary of State