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MEDICAL DIRECTORS OF IDAHO PLLC

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Company Details

Name: MEDICAL DIRECTORS OF IDAHO PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 23 Jun 2014 (11 years ago)
Financial Date End: 30 Jun 2025
Entity Number: 424684
Place of Formation: IDAHO
File Number: 424684
ZIP code: 83616
County: Ada County
Principal Address: 2885 S WHITE CASTLE AVE EAGLE, ID 83616
Mailing Address: 2885 S WHITE CASTLE AVE EAGLE, ID 83616-6832

Agent

Name Role Address
Ryan J Williams Agent 2885 S WHITE CASTLE AVE, EAGLE, ID 83616

Manager

Name Role Address Appointed On
Ryan J Williams Manager 2885 S. WHITE CASTLE AVE., EAGLE, ID 83616 2020-09-02

National Provider Identifier

NPI Number:
1710392410
Certification Date:
2023-05-16

Authorized Person:

Name:
RYAN WILLIAMS
Role:
RESPONSIBLE PARTY/REPRESENTATIVE
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2089473465

Filing

Filing Name Filing Number Filing date
Annual Report 0005842551 2024-08-05
Application for Reinstatement 0005400926 2023-09-13
Dissolution/Revocation - Administrative 0004913811 2022-09-15
Annual Report 0004264478 2021-05-03
Change of Registered Office/Agent/Both (by Entity) 0004150534 2021-02-02

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Date of last update: 01 Jul 2025

Sources: Idaho Secretary of State