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Fremont Medical Center, PLLC

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Company Details

Name: Fremont Medical Center, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 31 May 2021 (4 years ago)
Financial Date End: 31 May 2026
Entity Number: 4294294
Place of Formation: IDAHO
File Number: 765993
ZIP code: 83445
County: Fremont County
Principal Address: 30 W MAIN ST SAINT ANTHONY, ID 83445-2113

Agent

Name Role Address
JAMIE GUDMUNSON Agent 577 N 2800 E, SAINT ANTHONY, ID 83445

Member

Name Role Address Appointed On Resigned On
Jamie Gudmunson Member 577 N 2800 E, ST. ANTHONY, ID 83445 2022-04-17 2024-05-03
Cody Gudmunson Member 577 N 2800 E, ST. ANTHONY, ID 83445 2023-04-10 No data

National Provider Identifier

NPI Number:
1043931637
Certification Date:
2022-12-08

Authorized Person:

Name:
JAMIE GUDMUNSON
Role:
OWNER/ NURSE PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006202384 2025-04-09
Annual Report 0005717188 2024-05-03
Annual Report 0005192844 2023-04-10
Amendment to Certificate 0004920601 2022-09-20
Annual Report 0004699880 2022-04-17

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Date of last update: 19 May 2025

Sources: Idaho Secretary of State