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mmMedical Group, LLC

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Company Details

Name: mmMedical Group, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Oct 2019 (6 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 3647048
Place of Formation: IDAHO
File Number: 683770
ZIP code: 83702
County: Ada County
Principal Address: 405 223 N 6TH ST BOISE, ID 83702
Mailing Address: STE 100 801 N STILSON RD BOISE, ID 83703-5142

Agent

Name Role Address
Jay Holmes Agent 801 N STILSON RD, STE 100, BOISE, ID 83703

Member

Name Role Address Appointed On Resigned On
Medical Management, Inc. Member 9858 W STATE ST, STAR, ID 83669 2020-09-03 No data
Kara DeLacy Member 801 N STILSON RD, BOISE, ID 83703 2023-09-05 2024-09-12

U.S. Small Business Administration Profile

Phone Number:
E-mail Address:
Contact Person:
KYLEE HOMAN
Ownership and Self-Certifications:
Self-Certified Small Disadvantaged Business, Women-Owned Small Business, Woman Owned
User ID:
P2815466

Unique Entity ID

Unique Entity ID:
VUUDNKJT63J9
CAGE Code:
959S2
UEI Expiration Date:
2025-08-09

Business Information

Activation Date:
2024-08-13
Initial Registration Date:
2021-09-02

National Provider Identifier

NPI Number:
1548890460
Certification Date:
2020-09-23

Authorized Person:

Name:
RANDY EVARO
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report Amendment 0006230522 2025-05-03
Annual Report 0005899267 2024-09-12
Statement of Change of Business Mailing Address 0005860398 2024-08-13
Annual Report 0005381396 2023-09-05
Annual Report 0004912571 2022-09-14

USAspending Awards / Financial Assistance

Date:
2020-04-24
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
1000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State