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HERITAGE PHYSICIAN AND RESOURCE GROUP, LLC

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Company Details

Name: HERITAGE PHYSICIAN AND RESOURCE GROUP, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 27 Feb 2015 (10 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 451699
Place of Formation: IDAHO
File Number: 451699
ZIP code: 83202
County: Bannock County
Principal Address: 1009 W QUINN RD POCATELLO, ID 83202
Mailing Address: 1009 W QUINN ROAD POCATELLO, ID 83202

Agent

Name Role Address
Jonny Fisher Agent 850 DELL ROAD, CHUBBUCK, ID 83202

Member

Name Role Address Appointed On Resigned On
Pinnacle Health Services Member 182 N UNION AVE, FARMINGTON, UT 84025 2021-01-05 2023-01-31
Troy Bell Member 3076 LOIS LANE, POCATELLO, ID 83201 2024-01-03 2024-01-03

Manager

Name Role Address Appointed On
Blackline Financial LLC Manager 850 DELL ROAD, CHUBBUCK, ID 83202 2024-01-03

National Provider Identifier

NPI Number:
1962896027
Certification Date:
2024-08-15

Authorized Person:

Name:
JONNY RYAN FISHER
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

Fax:
2082380055

Filing

Filing Name Filing Number Filing date
Annual Report 0006071225 2025-01-15
Annual Report 0005538002 2024-01-03
Amendment to Certificate 0005397958 2023-09-11
Annual Report 0005086675 2023-01-31
Annual Report 0004550304 2022-01-03

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Date of last update: 11 May 2025

Sources: Idaho Secretary of State