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Ketchum Family Medicine, PLLC

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Company Details

Name: Ketchum Family Medicine, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 26 Aug 2020 (5 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 3979570
Place of Formation: IDAHO
File Number: 723188
ZIP code: 83340
County: Blaine County
Principal Address: ASHLEY BROWN PA-C 431 WALNUT AVE N KETCHUM, ID 83340
Mailing Address: ASHLEY BROWN PA-C PO BOX 6471 KETCHUM, ID 83340-6471

Agent

Name Role Address
Ashley Brown Agent 671 3RD AVE N, KETCHUM, ID 83340

Member

Name Role Address Appointed On
James Tautkus Member PO BOX 6471, KETCHUM, ID 83340 2020-10-27

Manager

Name Role Address Appointed On Resigned On
Ashley Brown Manager 431 WALNUT AVE N, KETCHUM, ID 83340 2020-09-03 2020-10-27

National Provider Identifier

NPI Number:
1720692650
Certification Date:
2020-11-12

Authorized Person:

Name:
MRS. ASHLEY BROWN
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005810620 2024-07-08
Annual Report 0005391140 2023-09-08
Annual Report 0004802287 2022-07-05
Annual Report 0004334600 2021-07-06
Amendment to Certificate 0004042559 2020-10-27

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State