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Core Medicine Idaho, LLC
Company Details
| Name: |
Core Medicine Idaho, LLC |
| Jurisdiction: |
Idaho |
| Legal type: |
Limited Liability Company (D) |
| Status: |
Active-Existing
|
| Date of registration: |
25 Apr 2022 (3 years ago)
|
| Financial Date End: |
30 Apr 2026 |
| Entity Number: |
4714525 |
| Place of Formation: |
IDAHO |
| File Number: |
818744 |
| ZIP code: |
83642
|
| County: |
Ada County |
| Principal Address: |
6109 S. TARREGA LANE MERIDIAN, ID 83642 |
| Mailing Address: |
AMBER MAHAN STE 101 4605 ENTERPRISE WAY CALDWELL, ID 83605-6889 |
Manager
| Name |
Role |
Address |
Appointed On |
|
P. Roman Burk
|
Manager
|
6109 S. TARREGA LANE, MERIDIAN, ID 83642
|
2023-04-04
|
Member
| Name |
Role |
Address |
Appointed On |
Resigned On |
|
JONATHAN CHU
|
Member
|
8358 W. CORY ST, BOISE, ID 83704
|
2024-03-18
|
2024-03-18
|
|
AMBER D MAHAN
|
Member
|
4353 S SKYRIDGE WAY, BOISE, ID 83605
|
2024-03-18
|
2024-03-18
|
Agent
| Name |
Role |
Address |
|
P Roman Burk
|
Agent
|
4605 ENTERPRISE WAY, STE 101, AMBER MAHAN, CALDWELL, ID 83605-6889
|
National Provider Identifier
Certification Date:
2024-01-16
Authorized Person:
Taxonomy:
Selected Taxonomy:
261QU0200X - Urgent Care Clinic/Center
Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Contacts:
This company hasn't received any reviews.
Date of last update: 09 Jul 2025
Sources:
Idaho Secretary of State
