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Snake River Pediatrics, PC

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Company Details

Name: Snake River Pediatrics, PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 11 Jan 2021 (4 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 4129216
Place of Formation: IDAHO
File Number: 741667
ZIP code: 83619
County: Payette County
Mailing Address: CHELSEY BIDWELL 1100 NW 12TH ST FRUITLAND, ID 83619

Agent

Name Role Address
Chelsey M Bidwell Agent 1100 NW 12TH ST, CHELSEY BIDWELL, FRUITLAND, ID 83619

Director

Name Role Address Appointed On Resigned On
Mary L James Director 1100 NW 12TH ST, FRUITLAND, ID 83619 2023-12-04 2023-12-04
Sage B Stringer Director 1100 NW 12TH ST, FRUITLAND, ID 83619 2023-12-04 2023-12-04

Treasurer

Name Role Address Appointed On Resigned On
Chelsey M Bidwell Treasurer 1100 NW 12TH ST, FRUITLAND, ID 83619 2023-12-04 2023-12-04

Secretary

Name Role Address Appointed On Resigned On
Chelsie M Lewis Secretary 1100 NW 12TH ST, FRUITLAND, ID 83619 2023-12-04 2023-12-04

President

Name Role Address Appointed On Resigned On
Matthew J Berria PhD President 1100 NW 12TH ST, FRUITLAND, ID 83619 2023-12-04 2023-12-04

Vice President

Name Role Address Appointed On
Michelle F DeVoe DO Vice President 1100 NW 12TH ST, FRUITLAND, ID 83619 2022-01-12

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
C1VXBZ1CM7L1
UEI Expiration Date:
2026-01-30

Business Information

Division Name:
SNAKE RIVER PEDIATRICS, PC
Activation Date:
2025-02-03
Initial Registration Date:
2023-09-14

National Provider Identifier

NPI Number:
1871952267
Certification Date:
2024-02-01

Authorized Person:

Name:
MATTHEW JOSEPH BERRIA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363LP0200X - Pediatric Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
5412166557

Form 5500 Series

Employer Identification Number (EIN):
471779788
Plan Year:
2023
Number Of Participants:
45
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006009148 2024-12-05
Annual Report 0005497783 2023-12-04
Annual Report 0005013601 2022-12-05
Annual Report 0004566268 2022-01-12
Initial Filing 0004129216 2021-01-11

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Date of last update: 15 Apr 2025

Sources: Idaho Secretary of State