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ST. LUKE'S IDAHO CARDIOLOGY ASSOCIATES

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Company Details

Name: ST. LUKE'S IDAHO CARDIOLOGY ASSOCIATES
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 23 Jan 2009 (16 years ago)
Entity Number: 391004
Place of Formation: IDAHO
File Number: 0000391004
ZIP code: 83712
County: Ada County
Mailing Address: 190 E BANNOCK ST BOISE, ID 83712

National Provider Identifier

NPI Number:
1306137633

Authorized Person:

Name:
MR. JAMES A MATTES
Role:
PRESIDENT/CEO
Phone:

Taxonomy:

Selected Taxonomy:
207RC0000X - Cardiovascular Disease Physician
Is Primary:
Yes

Contacts:

Fax:
5419631845

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000881866 2012-03-20
Initial Filing 0000391004 2009-01-23

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State