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Idaho Surgical, L.L.C.

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Company Details

Name: Idaho Surgical, L.L.C.
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 01 Jan 2019 (7 years ago)
Financial Date End: 31 Jan 2024
Date dissolved: 12 Apr 2024
Entity Number: 3385903
Place of Formation: IDAHO
File Number: 648706
ZIP code: 83616
County: Ada County
Principal Address: 1662 S. LAKE CREST WAY EAGLE, ID 83616
Mailing Address: 1662 S LAKE CREST WAY EAGLE, ID 83616-7142

Agent

Name Role Address
Bren Heaton Agent 1662 S LAKE CREST WAY, EAGLE, ID 83616

Member

Name Role Address Appointed On
Rhoda Heaton Member 1662 S. LAKE CREST WAY, EAGLE, ID 83616 2021-02-08

National Provider Identifier

NPI Number:
1790340834

Authorized Person:

Name:
DR. BREN HEATON
Role:
SURGEON/OWNER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005689751 2024-04-12
Annual Report 0005105491 2023-02-09
Annual Report 0004556272 2022-01-06
Annual Report 0004168754 2021-02-08
Annual Report 0003824034 2020-04-02

Paycheck Protection Program

Jobs Reported:
2
Initial Approval Amount:
$17,500
Date Approved:
2020-04-09
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$17,500
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$17,652.95
Servicing Lender:
Glacier Bank
Use of Proceeds:
Payroll: $17,500

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Date of last update: 06 Jul 2025

Sources: Idaho Secretary of State