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Precision Family Medicine & Aesthetics LLC.

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Company Details

Name: Precision Family Medicine & Aesthetics LLC.
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 03 Aug 2022 (3 years ago)
Financial Date End: 31 Aug 2025
Date dissolved: 15 Nov 2024
Entity Number: 4841100
Place of Formation: IDAHO
File Number: 834445
ZIP code: 83404
County: Bonneville County
Mailing Address: STE 4 2001 S WOODRUFF AVE IDAHO FALLS, ID 83404-6371

Member

Name Role Address Appointed On
DEREK M VAN ORDEN Member 2001 S. WOODRUFF AVE., IDAHO FALLS, ID 83404 2022-08-30

Agent

Name Role Address
DEREK M VAN ORDEN Agent 2001 S WOODRUFF AVE, STE 11, IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1760119986
Certification Date:
2022-10-13

Authorized Person:

Name:
MR. BRADLEY RADFORD
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0006045829 2025-01-03
Dissolution/Revocation - Administrative 0005982666 2024-11-15
Amendment to Certificate 0005601981 2024-02-28
Statement of Change of Business Mailing Address 0005569799 2024-01-23
Dissolution/Revocation - Administrative 0005480061 2023-11-16

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Date of last update: 25 Mar 2025

Sources: Idaho Secretary of State