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Center for Surgery PLLC

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Company Details

Name: Center for Surgery PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Nov 2019 (6 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 3673874
Place of Formation: IDAHO
File Number: 687115
ZIP code: 83404
County: Bonneville County
Principal Address: SUITE A 3369 MERLIN DRIVE IDAHO FALLS, ID 83404
Mailing Address: STE A 3369 MERLIN DR IDAHO FALLS, ID 83404-7405

Agent

Name Role Address
GARY W WALLACE MD Agent 3395 MERLIN DR, STE A, GARY W WALLACE, IDAHO FALLS, ID 83404

Manager

Name Role Address Appointed On Resigned On
Gary W Wallace Manager 378 CRANBROOK LANE, IDAHO FALLS, ID 83404 2021-11-16 No data
Gary W Wallace MD Manager 378 CRANBROOK LANE, IDAHO FALLS, ID 83404 2020-10-06 No data
Alicia Raya-Elizondo Manager 3369 MERLIN DR., IDAHO FALLS, ID 83404 2020-10-06 2020-10-06

Member

Name Role Address Appointed On Resigned On
Cynthia A Wallace Member 378 CRANBROOK LANE, IDAHO FALLS, ID 83404 2023-11-09 2023-11-09

National Provider Identifier

NPI Number:
1467097725

Authorized Person:

Name:
MR. GARY W. WALLACE
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006054493 2025-01-07
Annual Report 0005475162 2023-11-09
Annual Report 0004950319 2022-10-12
Annual Report Amendment 0004799405 2022-07-01
Annual Report 0004499402 2021-11-16

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State