| Name: | PEDIATRIC INTENSIVISTS OF IDAHO, PLLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Inactive-Dissolved |
| Date of registration: | 27 Jan 2021 (4 years ago) |
| Financial Date End: | 31 Jan 2024 |
| Date dissolved: | 04 Jan 2024 |
| Entity Number: | 4145088 |
| Place of Formation: | IDAHO |
| File Number: | 744460 |
| ZIP code: | 83703 |
| County: | Ada County |
| Principal Address: | 2812 N 32ND ST BOISE, ID 83703 |
| Mailing Address: | 2812 N 32ND ST BOISE, ID 83703-5306 |
| Name | Role | Address |
|---|---|---|
| MICHELLE T GARDNER, M.D. | Agent | 2812 N 32ND ST, BOISE, ID 83703 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| MICHELLE T GARDNER, MD | Member | 2812 N 32ND ST, BOISE, ID 83703 | 2022-01-03 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Statement of Dissolution | 0005541525 | 2024-01-04 |
| Annual Report | 0005114911 | 2023-02-13 |
| Annual Report | 0004551310 | 2022-01-03 |
| Initial Filing | 0004145088 | 2021-01-27 |
Date of last update: 03 Jan 2025
Sources: Idaho Secretary of State
