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SURGICAL BARIATRICS NORTHWEST, INC., P.A.

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Company Details

Name: SURGICAL BARIATRICS NORTHWEST, INC., P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 02 Oct 2000 (25 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 414422
Place of Formation: IDAHO
File Number: 414422
ZIP code: 83854
County: Kootenai County
Mailing Address: STE 205 750 N SYRINGA ST POST FALLS, ID 83854-5275

Secretary

Name Role Address Appointed On Resigned On
Terese Fandel Secretary 750 N. SYRINGA STREET, POST FALLS, ID 83854 2020-11-02 2023-12-14
DEREK DIRKS Secretary 911 N BALCONY DR., COEUR D'ALENE, ID 83814 2023-12-14 No data

Vice President

Name Role Address Appointed On
CORY RICHARDSON Vice President 6295 W HARBOR DR, POST FALLS, ID 83854 2023-12-14

President

Name Role Address Appointed On
JOHN PENNINGS President 4318 E DEEPWATER LOOP, HAYDEN, ID 83835 2023-12-14
John Pennings President 750 N. SYRINGA STREET, POST FALLS, ID 83854 2023-10-31

Agent

Name Role Address
John L Pennings Agent 750 N SYRINGA ST, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1033127659

Authorized Person:

Name:
DR. JOHN L. PENNINGS
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2084150150

Form 5500 Series

Employer Identification Number (EIN):
820527714
Plan Year:
2023
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
5
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
3
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005950592 2024-10-25
Annual Report Amendment 0005511504 2023-12-14
Articles of Amendment 0005510473 2023-12-13
Annual Report 0005452973 2023-10-31
Annual Report 0004963493 2022-10-27

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Date of last update: 30 Jun 2025

Sources: Idaho Secretary of State