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CLAY I. CAMPBELL, M.D., P.C.

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Company Details

Name: CLAY I. CAMPBELL, M.D., P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 14 Aug 2003 (22 years ago)
Financial Date End: 31 Aug 2021
Date dissolved: 17 Nov 2021
Entity Number: 457649
Place of Formation: IDAHO
File Number: 457649
ZIP code: 83254
County: Bear Lake County
Mailing Address: 166 S 5TH ST MONTPELIER, ID 83254-4959

Agent

Name Role Address
CLAY I CAMPBELL MD Agent 166 S 5TH ST, MONTPELIER, ID 83254

President

Name Role Address Appointed On
Clay I Campbell MD President 166 S 5TH ST, MONTPELIER, ID 83254-4959 2020-09-02

National Provider Identifier

NPI Number:
1295813475

Authorized Person:

Name:
CLAY I CAMPBELL
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2088471620

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004499922 2021-11-17
Annual Report 0003990150 2020-09-02
Annual Report 0003590106 2019-08-07
Annual Report 0002930616 2018-06-19
Annual Report 0002930614 2017-06-22

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Date of last update: 08 Apr 2025

Sources: Idaho Secretary of State