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DERMATOLOGY CENTER OF CANYON COUNTY, PLLC

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Company Details

Name: DERMATOLOGY CENTER OF CANYON COUNTY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 15 Mar 2004 (21 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 467088
Place of Formation: IDAHO
File Number: 467088
ZIP code: 83651
County: Canyon County
Principal Address: 318 2ND ST S NAMPA, ID 83651-3765

Agent

Name Role Address
GAVIN R POWELL Agent 318 2ND ST S, NAMPA, ID 83651

Member

Name Role Address Appointed On
Gavin R. Powell Member 318 2ND ST S, NAMPA, ID 83651-3765 2022-02-06

Governor

Name Role Address Appointed On Resigned On
Gavin R. Powell Governor 318 2ND ST S, NAMPA, ID 83651-3765 2021-06-01 2022-02-06

Secretary

Name Role Address Appointed On
Michele L Powell Secretary 17793 POLARA WAY, NAMPA, ID 83687 2021-02-03

National Provider Identifier

NPI Number:
1578694238

Authorized Person:

Name:
DR. GAVIN R POWELL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
2084671155

Filing

Filing Name Filing Number Filing date
Annual Report 0006099232 2025-02-06
Annual Report 0005587189 2024-02-06
Annual Report 0005137372 2023-03-05
Annual Report 0004597559 2022-02-06
Statement of Conversion 0004294948 2021-06-01

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Date of last update: 11 May 2025

Sources: Idaho Secretary of State