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Inland Orthopaedic Surgery and Sports Medicine Clinic, PLLC

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Company Details

Name: Inland Orthopaedic Surgery and Sports Medicine Clinic, PLLC
Jurisdiction: Idaho
Legal type: Professional Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Oct 2018 (7 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 3308012
Place of Formation: IDAHO
File Number: 639409
ZIP code: 83843
County: Latah County
Principal Address: STE 201 2500 W A STREET MOSCOW, ID 83843
Mailing Address: STE 201 2500 W A ST MOSCOW, ID 83843-6000

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 1305 12TH AVE RD, NAMPA, ID 83686

Member

Name Role Address Appointed On Resigned On
Edwin M. Tingstad, MD, PLLC Member 2500 W A STREET, MOSCOW, ID 83843 2021-09-03 No data
Kyle Hazelwood MD PLLC Member 2500 WEST A STREET, MOSCOW, ID 83843 2023-10-03 2023-10-03
Aaron J Vandenbos MD Member 2500 W A ST, MOSCOW, ID 83843 2023-10-03 No data
Mathew Z Taylor MD Member 2500 W A ST, MOSCOW, ID 83843 2023-10-03 No data

National Provider Identifier

NPI Number:
1952877763

Authorized Person:

Name:
BARBARA COCHRAN
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2088822179

Filing

Filing Name Filing Number Filing date
Amendment to Certificate 0006068613 2025-02-07
Annual Report 0005955562 2024-10-31
Change of Registered Office/Agent/Both (by Entity) 0005774121 2024-06-27
Amendment to Certificate 0005441751 2023-10-16
Annual Report 0005417830 2023-10-03

USAspending Awards / Financial Assistance

Date:
2020-04-30
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:
292201.24
Total Face Value Of Loan:
292201.24

Paycheck Protection Program

Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
292201.24
Current Approval Amount:
292201.24
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
295099.24

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Date of last update: 16 May 2025

Sources: Idaho Secretary of State