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PHILIP D. JENSEN, M.D., CHARTERED

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Company Details

Name: PHILIP D. JENSEN, M.D., CHARTERED
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 08 Aug 2005 (20 years ago)
Financial Date End: 31 Aug 2024
Date dissolved: 15 Nov 2024
Entity Number: 491330
Place of Formation: IDAHO
File Number: 491330
ZIP code: 83702
County: Ada County
Mailing Address: 425 W BANNOCK ST BOISE, ID 83702-6035

Agent

Name Role Address
PHILIP D JENSEN, M.D. Agent 425 W BANNOCK ST, BOISE, ID 83702

President

Name Role Address Appointed On
Philip D Jensen President 425 W BANNOCK ST, BOISE, ID 83702-6035 2020-07-21

National Provider Identifier

NPI Number:
1740480839

Authorized Person:

Name:
DR. PHILIP D JENSEN
Role:
PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
207RG0100X - Gastroenterology Physician
Is Primary:
Yes

Contacts:

Fax:
2083427042
Fax:
2083435031

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005984142 2024-11-15
Annual Report 0005398934 2023-09-12
Annual Report 0004823303 2022-07-14
Annual Report 0004360233 2021-07-28
Annual Report 0003944354 2020-07-21

Paycheck Protection Program

Jobs Reported:
1
Initial Approval Amount:
$28,541
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$28,541
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$28,737.62
Servicing Lender:
U.S. Bank, National Association
Use of Proceeds:
Payroll: $28,541

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Date of last update: 02 Jul 2025

Sources: Idaho Secretary of State