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PETRIE WHITE FAMILY MEDICINE OF IDAHO, PLLC

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Company Details

Name: PETRIE WHITE FAMILY MEDICINE OF IDAHO, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Apr 2011 (14 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 315356
Place of Formation: IDAHO
File Number: 315356
ZIP code: 83617
County: Gem County
Principal Address: 2001 E QUAIL RUN RD EMMETT, ID 83617
Mailing Address: 2001 E QUAIL RUN RD EMMETT, ID 83617-5059

Agent

Name Role Address
JENNIFER L PETRIE MD Agent 2001 E QUAIL RUN ROAD, EMMETT, ID 83617

Manager

Name Role Address Appointed On
Ryan E White Manager 2001 E QUAIL RUN ROAD, EMMETT, ID 83617 2021-03-08

National Provider Identifier

NPI Number:
1447629555

Authorized Person:

Name:
MR. RYAN EARL WHITE
Role:
CLINIC ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083654464

Filing

Filing Name Filing Number Filing date
Annual Report 0006141207 2025-03-04
Annual Report 0005632858 2024-03-04
Annual Report 0005155207 2023-03-14
Annual Report 0004686094 2022-04-04
Annual Report 0004201672 2021-03-08

USAspending Awards / Financial Assistance

Date:
2020-04-13
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:
10000.00
Total Face Value Of Loan:
10000.00
Date:
2020-04-13
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:
10000.00
Total Face Value Of Loan:
10000.00

Paycheck Protection Program

Jobs Reported:
8
Initial Approval Amount:
$10,000
Date Approved:
2020-04-12
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$10,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$10,077.54
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $10,000

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Date of last update: 01 Sep 2025

Sources: Idaho Secretary of State