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MOUNTAIN STATES MEDICAL GROUP, P.A.

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Company Details

Name: MOUNTAIN STATES MEDICAL GROUP, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved
Date of registration: 23 Jun 1998 (27 years ago)
Financial Date End: 30 Jun 2013
Date dissolved: 08 Apr 2013
Entity Number: 381695
Place of Formation: IDAHO
File Number: 0000381695
ZIP code: 83702
County: Ada County
Mailing Address: 2109 N. 21ST ST BOISE, ID 83702

National Provider Identifier

NPI Number:
1730272006

Authorized Person:

Name:
RICHARD MCCHRYSTAL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083239070

Filing

Filing Name Filing Number Filing date
Articles of Dissolution 0000878586 2013-04-08
Annual Report 0002637353 2012-05-01
Annual Report 0002637349 2011-05-16
Annual Report 0002637348 2010-07-08
Annual Report 0002637347 2009-04-15

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State