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EVENING MEDICAL CLINIC

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Company Details

Name: EVENING MEDICAL CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 25 Jun 1997 (28 years ago)
Entity Number: 32059
Place of Formation: IDAHO
File Number: 0000032059
ZIP code: 83318
County: Cassia County
Mailing Address: 1308 BENNETT STE A BURLEY, ID 83318

National Provider Identifier

NPI Number:
1043412133

Authorized Person:

Name:
MICHAEL P KLETT
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QH0100X - Health Service Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2088782005

Filing

Filing Name Filing Number Filing date
Initial Filing 0000032059 1997-06-25

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State