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Total Health Physician Group, LLC

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Company Details

Name: Total Health Physician Group, LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Inactive-Revoked (Administrative)
Date of registration: 24 Jul 2019 (6 years ago)
Financial Date End: 31 Jul 2022
Date dissolved: 05 Oct 2022
Branch of: Total Health Physician Group, LLC, WASHINGTON (Company Number undefined602556271)
Entity Number: 3577854
Place of Formation: WASHINGTON
File Number: 674464
ZIP code: 83843
County: Latah County
Principal Address: VALERIE CARPENTER 619 S WASHINGTON ST., SUITE 203 MOSCOW, ID 83843
Mailing Address: VALERIE CARPENTER STE 203 619 S WASHINGTON ST MOSCOW, ID 83843-3063

Manager

Name Role Address Appointed On
Robert N Spady Manager 619 S WASHINGTON STREET, MOSCOW, ID 83843 2020-07-08

National Provider Identifier

NPI Number:
1043492655
Certification Date:
2021-03-11

Authorized Person:

Name:
DR. ROBERT N SPADY
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2088928306

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004937258 2022-10-05
Annual Report 0004385665 2021-08-16
Annual Report 0003935475 2020-07-08
Initial Filing 0003577854 2019-07-24

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Date of last update: 06 Jul 2025

Sources: Idaho Secretary of State