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Idaho Cleft and Craniofacial Pediatric Plastic Surgery, P.A.

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Company Details

Name: Idaho Cleft and Craniofacial Pediatric Plastic Surgery, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 13 Feb 2003 (22 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 449475
Place of Formation: IDAHO
File Number: 449475
ZIP code: 83712
County: Ada County
Mailing Address: STE 303 100 E IDAHO ST BOISE, ID 83712-6269

Agent

Name Role Address
RUSSELL H GRIFFITHS Agent 100 E IDAHO ST, STE 303, BOISE, ID 83712

President

Name Role Address Appointed On
Russell Griffiths Dr President 100 E. IDAHO ST., BOISE, ID 83712 2021-01-04

National Provider Identifier

NPI Number:
1184899973
Certification Date:
2023-05-08

Authorized Person:

Name:
RUSSELL H GRIFFITHS
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208200000X - Plastic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2084331738

Filing

Filing Name Filing Number Filing date
Annual Report 0006054648 2025-01-07
Annual Report 0005535043 2024-01-03
Articles of Amendment 0005185986 2023-04-07
Annual Report 0005046013 2023-01-03
Annual Report 0004548373 2022-01-03

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Date of last update: 01 Jul 2025

Sources: Idaho Secretary of State