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BOISE ENDOSCOPY CENTER, LLC

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Company Details

Name: BOISE ENDOSCOPY CENTER, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 13 Oct 1998 (27 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 36995
Place of Formation: IDAHO
File Number: 36995
ZIP code: 83702
County: Ada County
Principal Address: 425 W BANNOCK ST BOISE, ID 83702
Mailing Address: EDDY MCLANE 425 W BANNOCK ST BOISE, ID 83702-6035

Agent

Name Role Address
Brian Story Agent 425 W BANNOCK ST, BOISE, ID 83702-6035

Member

Name Role Address Appointed On
David Wood Member 425 W BANNOCK ST, BOISE, ID 83702 2020-09-03
Akshay Gupta Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Erin McCoy Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Justin Tomal Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Philip Jensen Member 425 W BANNOCK ST, BOISE, ID 83702 2023-09-12
Bonnie Kim Waite Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Christopher Hammerle Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Brian Story Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Kirsten Morigeau Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12
Robert Lockwood Member 425 W BANNOCK ST, BOISE, ID 83702-6035 2023-09-12

National Provider Identifier

NPI Number:
1689332959
Certification Date:
2023-06-15

Authorized Person:

Name:
REBECCA BUTTERFIELD
Role:
CREDENTIALING MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2083435031
Fax:
2083680863

Filing

Filing Name Filing Number Filing date
Annual Report 0005877807 2024-09-03
Annual Report 0005398944 2023-09-12
Annual Report 0004884366 2022-09-06
Annual Report 0004424509 2021-09-21
Annual Report 0003995641 2020-09-03

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Date of last update: 25 May 2025

Sources: Idaho Secretary of State