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RONALD S. HIGGINBOTHAM, D.O., P.A.

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Company Details

Name: RONALD S. HIGGINBOTHAM, D.O., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 18 Jul 1996 (29 years ago)
Financial Date End: 31 Jul 2026
Entity Number: 356042
Place of Formation: IDAHO
File Number: 356042
ZIP code: 83704
County: Ada County
Mailing Address: 7685 W EMERALD ST BOISE, ID 83704-9018

Agent

Name Role Address
RONALD S HIGGINBOTHAM Agent 7685 W EMERALD ST, BOISE, ID 83704

Secretary

Name Role Address Appointed On Resigned On
Jane M Higginbotham Secretary 7685 W EMERALD ST, BOISE, ID 83704 2024-06-03 2024-06-03

Vice President

Name Role Address Appointed On Resigned On
JANE M HIGGINBOTHAM Vice President 7685 W EMERALD ST, BOISE, ID 83704 2024-06-03 2024-06-03

President

Name Role Address Appointed On
Ronald S HIGGINBOTHAM President 7685 W EMERALD ST, BOISE, ID 83704 2021-06-03

National Provider Identifier

NPI Number:
1306984943

Authorized Person:

Name:
MS. AMY E HUMMEL
Role:
OFFICE MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2083755860

Filing

Filing Name Filing Number Filing date
Annual Report 0006299854 2025-06-04
Annual Report 0005757215 2024-06-03
Annual Report 0005267393 2023-06-05
Annual Report 0004767270 2022-06-03
Annual Report 0004303791 2021-06-03

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Date of last update: 06 Aug 2025

Sources: Idaho Secretary of State