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MIRANDA MEDICAL, PLLC

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Company Details

Name: MIRANDA MEDICAL, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 25 Sep 2013 (12 years ago)
Financial Date End: 30 Sep 2020
Date dissolved: 08 Dec 2020
Entity Number: 396054
Place of Formation: IDAHO
File Number: 0000396054
ZIP code: 83616
County: Ada County
Principal Address: PO BOX 2047 EAGLE, ID 83616
Mailing Address: RICHARD MIRANDA 3526 W OLD GOLD DR MERIDIAN, ID 83646-4813

Agent

Name Role Address
A RICHARD MIRANDA, M.D. Agent 3526 WEST OLD GOLD DRIVE, MERIDIAN, ID 83646

National Provider Identifier

NPI Number:
1053765545

Authorized Person:

Name:
DR. A RICHARD MIRANDA
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
207RH0003X - Hematology & Oncology Physician
Is Primary:
No
Selected Taxonomy:
207RH0003X - Hematology & Oncology Physician
Is Primary:
Yes

Contacts:

Fax:
2083297159

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004092287 2020-12-08
Annual Report 0003710553 2019-12-16
Annual Report 0003369289 2018-12-11
Annual Report 0002698290 2017-10-21
Annual Report 0002698289 2016-10-20

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State