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Magic Valley Urology, pllc

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Company Details

Name: Magic Valley Urology, pllc
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 12 Oct 2020 (5 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 4030389
Place of Formation: IDAHO
File Number: 729494
ZIP code: 83301
County: Twin Falls County
Principal Address: SUITE 201 401 GOODING ST N TWIN FALLS, ID 83301
Mailing Address: PO BOX 1293 TWIN FALLS, ID 83303-1293

Agent

Name Role Address
John Coleman Agent 401 GOODING ST N, SUITE 201, TWIN FALLS, ID 83301

Manager

Name Role Address Appointed On
Joel Hancock, MD PLLC Manager PO BOX 1293, TWIN FALLS, ID 83303 2023-09-04
Jason R. Greenhalgh, MD, PA Manager PO BOX 1293, TWIN FALLS, ID 83303 2021-10-07

National Provider Identifier

NPI Number:
1790388700
Certification Date:
2020-11-20

Authorized Person:

Name:
JASON GREENHALGH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208800000X - Urology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
853464087
Plan Year:
2023
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
2
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005893459 2024-09-07
Annual Report 0005380148 2023-09-04
Annual Report 0004884142 2022-09-05
Annual Report 0004441321 2021-10-07
Initial Filing 0004030389 2020-10-12

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State