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MOUNTAIN STATES NEONATOLOGY, INC.

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Company Details

Name: MOUNTAIN STATES NEONATOLOGY, INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 24 Feb 1999 (26 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 390823
Place of Formation: IDAHO
File Number: 390823
Mailing Address: 1301 CONCORD TERRACE SUNRISE, FL 33323

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 10020 W FAIRVIEW AVE, STE 104, BOISE, ID 83704

Director

Name Role Address Appointed On Resigned On
Roger Mack Hinson MD Director 1301 CONCORD TERRACE, SUNRISE, FL 33323 2021-01-12 2024-01-10
Cameron Swinton M.D. Director 1301 CONCORD TERRACE, SUNRISE, FL 33323 2024-01-10 No data

Secretary

Name Role Address Appointed On
Michael R. Santana Secretary 1301 CONCORD TERRACE, SUNRISE, FL 33323 2024-01-10

Treasurer

Name Role Address Appointed On Resigned On
Kasandra Rossi Treasurer 1301 CONCORD TERRACE, SUNRISE, FL 33323 2024-01-10 2024-01-10

President

Name Role Address Appointed On
Cameron Swinton M.D. President 1301 CONCORD TERRACE, SUNRISE, FL 33323 2024-01-10

National Provider Identifier

NPI Number:
1205850823
Certification Date:
2024-10-23

Authorized Person:

Name:
NANETTE SANDERS
Role:
RCM DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207VM0101X - Maternal & Fetal Medicine Physician
Is Primary:
No
Selected Taxonomy:
2080P0203X - Pediatric Critical Care Medicine Physician
Is Primary:
No
Selected Taxonomy:
363LN0000X - Neonatal Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
2080N0001X - Neonatal-Perinatal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083677616

Filing

Filing Name Filing Number Filing date
Registered Agent Name/Address Change (mass change) 0006276126 2025-05-27
Annual Report 0006061525 2025-01-10
Annual Report 0005558086 2024-01-10
Annual Report 0005060493 2023-01-10
Registered Agent Name/Address Change (mass change) 0004898547 2022-09-12

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Date of last update: 07 Aug 2025

Sources: Idaho Secretary of State