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SNAKE RIVER DERMATOLOGY, P.A.

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Company Details

Name: SNAKE RIVER DERMATOLOGY, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 13 Apr 2004 (21 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 468524
Place of Formation: IDAHO
File Number: 468524
ZIP code: 83619
County: Payette County
Mailing Address: Brock Andersen 2101 N WHITLEY DR FRUITLAND, ID 83619-2132

Agent

Name Role Address
BROCK ANDERSEN Agent 2101 N. WHITLEY DR, FRUITLAND, ID 83619

President

Name Role Address Appointed On
Brock Andersen President 5016 SARAH CT., FRUITLAND, ID 83619 2021-03-03

National Provider Identifier

NPI Number:
1528263670

Authorized Person:

Name:
DR. BROCK ARBEN ANDERSEN II
Role:
PRINCIPAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
No
Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
2084524499

Form 5500 Series

Employer Identification Number (EIN):
161697626
Plan Year:
2023
Number Of Participants:
19
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
12
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006141558 2025-03-04
Annual Report 0005639236 2024-03-06
Annual Report 0005208747 2023-04-22
Annual Report 0004649342 2022-03-08
Annual Report 0004189965 2021-03-03

USAspending Awards / Financial Assistance

Date:
2020-06-11
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
31.00
Total Face Value Of Loan:
187231.00

Paycheck Protection Program

Jobs Reported:
12
Initial Approval Amount:
$187,200
Date Approved:
2020-04-12
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$187,231
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$188,775.01
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $187,231

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Date of last update: 05 Sep 2025

Sources: Idaho Secretary of State