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MADISON AVENUE SURGERY CENTER LLC

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Company Details

Name: MADISON AVENUE SURGERY CENTER LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 27 Oct 2015 (10 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 479427
Place of Formation: IDAHO
File Number: 479427
ZIP code: 83404
County: Bonneville County
Principal Address: 1855 MADISON AVE IDAHO FALLS, ID 83404
Mailing Address: BRETT MAXFIELD STE B 1855 MADISON AVE IDAHO FALLS, ID 83404-1212

Agent

Name Role Address
MARK FREEMAN Agent 1855 MADISON AVE, IDAHO FALLS, ID 83404

Manager

Name Role Address Appointed On
Mark Freeman Manager 1855 MADISON AVE, IDAHO FALLS, ID 83404 2020-09-03

Member

Name Role Address Appointed On
Andrew L McCall Member 2920 CORTEZ AVE, IDAHO FALLS, ID 83401 2023-09-04
Kylin T Kovac Member 1540 ELK CREEK DRIVE, IDAHO FALLS, ID 83404 2023-09-04
Jed H Erickson Member 1540 ELK CREEK DRIVE, IDAHO FALLS, ID 83404 2023-09-04
Maxfield Healthcare Solutions Member 143 N 3762 E, RIGBY, ID 83442 2023-09-04
Bruce J Watkins Member 3369 MERLIN DRIVE, IFAHO FALLS, ID 83404 2023-09-04

National Provider Identifier

NPI Number:
1225488216

Authorized Person:

Name:
KIM BELL
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005877063 2024-09-03
Annual Report 0005380774 2023-09-04
Annual Report 0004890521 2022-09-08
Annual Report 0004402091 2021-09-03
Annual Report 0003994243 2020-09-03

USAspending Awards / Financial Assistance

Date:
2020-05-03
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
10000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-13
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:
45600.00
Total Face Value Of Loan:
45600.00

Paycheck Protection Program

Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
45600
Current Approval Amount:
45600
Race:
White
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
46048.5

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Date of last update: 12 May 2025

Sources: Idaho Secretary of State