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TONY C. ROISUM, M.D., P.A.

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Company Details

Name: TONY C. ROISUM, M.D., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 29 Sep 1997 (28 years ago)
Financial Date End: 30 Sep 2026
Entity Number: 371492
Place of Formation: IDAHO
File Number: 371492
ZIP code: 83404
County: Bonneville County
Mailing Address: 3360 WASHINGTON PKWY IDAHO FALLS, ID 83404-7592

President

Name Role Address Appointed On Resigned On
Tony Roisum President 7955 S. BLACKHAWK DR, IDAHO FALLS, ID 83406 2020-12-14 No data
Shellie Roisum President 4696 RADIANT DR, IDAHO FALLS, ID 83404 2024-10-25 2024-10-25
Matthew Merzlock President 3360 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7592 2025-08-03 No data

Agent

Name Role Address
GUARDIAN REGISTERED AGENTS LLC Agent 955 PIER VIEW DR, IDAHO FALLS, ID 83402

National Provider Identifier

NPI Number:
1124115944

Authorized Person:

Name:
TONY C ROISUM
Role:
OWNER / PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2085243138

Filing

Filing Name Filing Number Filing date
Annual Report 0006379437 2025-08-03
Change of Registered Office/Agent/Both (by Entity) 0005968571 2024-11-10
Articles of Amendment 0005968565 2024-11-06
Annual Report 0005950820 2024-10-25
Application for Reinstatement 0005552613 2024-01-09

Paycheck Protection Program

Jobs Reported:
16
Initial Approval Amount:
$161,800
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$161,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$163,879.02
Servicing Lender:
KeyBank National Association
Use of Proceeds:
Payroll: $161,800

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Date of last update: 06 Aug 2025

Sources: Idaho Secretary of State