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GLEN S. LOVELACE, M.D., P.A.

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Company Details

Name: GLEN S. LOVELACE, M.D., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 30 May 1996 (29 years ago)
Financial Date End: 31 May 2026
Entity Number: 354219
Place of Formation: IDAHO
File Number: 354219
ZIP code: 83702
County: Ada County
Mailing Address: STE 260 333 N 1ST ST BOISE, ID 83702-6132

Agent

Name Role Address
GLEN S LOVELACE Agent 333 N 1ST #260, BOISE, ID 83702

President

Name Role Address Appointed On Resigned On
Glen S Lovelace President 333 N 1ST ST. ST260, BOISE, ID 83702-6132 2020-08-10 2021-06-03
Glen Lovelace, MD President 333 N 1ST ST, BOISE, ID 83702 2025-04-23 No data

National Provider Identifier

NPI Number:
1023053204

Authorized Person:

Name:
DR. GLEN S LOVELACE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
2083450984

Form 5500 Series

Employer Identification Number (EIN):
820491054
Plan Year:
2022
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
7
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
13
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006215534 2025-04-23
Application for Reinstatement 0005903693 2024-09-18
Dissolution/Revocation - Administrative 0004859171 2022-08-12
Annual Report 0004299981 2021-06-03
Application for Reinstatement 0003959705 2020-08-10

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Date of last update: 29 Jun 2025

Sources: Idaho Secretary of State