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CAPITAL CITY FAMILY MEDICINE, P.A.

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Company Details

Name: CAPITAL CITY FAMILY MEDICINE, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 02 Nov 1998 (27 years ago)
Financial Date End: 30 Nov 2011
Date dissolved: 08 Feb 2012
Entity Number: 386506
Place of Formation: IDAHO
File Number: 0000386506
ZIP code: 83702
County: Ada County
Mailing Address: 1520 W STATE ST STE 100 BOISE, ID 83702

National Provider Identifier

NPI Number:
1992731319

Authorized Person:

Name:
MRS. LIZ A FRISBEY
Role:
OFFICE MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2089477711

Form 5500 Series

Employer Identification Number (EIN):
820506859
Plan Year:
2010
Number Of Participants:
26
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
30
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
30
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
29
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
29
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0002657817 2010-02-24
Application for Reinstatement 0000880323 2010-02-18
Annual Report 0002657816 2008-09-29
Annual Report 0002657815 2007-10-01
Annual Report 0002657813 2006-09-21

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State