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BONNIE KIM WAITE, M.D. CHARTERED

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Company Details

Name: BONNIE KIM WAITE, M.D. CHARTERED
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 14 Sep 2005 (20 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 493041
Place of Formation: IDAHO
File Number: 493041
ZIP code: 83702
County: Ada County
Mailing Address: EDDY MCLANE 425 W BANNOCK ST BOISE, ID 83702-6035

President

Name Role Address Appointed On
Bonnie Kim Waite President 425 W. BANNOCK ST, BOISE, ID 83702 2020-09-03

Treasurer

Name Role Address Appointed On
Darin Waite Treasurer 425 W. BANNOCK ST., BOISE, ID 83702 2023-09-12

Agent

Name Role Address
BONNIE KIM WAITE MD Agent 425 W BANNOCK ST, BOISE, ID 83702

National Provider Identifier

NPI Number:
1275733370

Authorized Person:

Name:
DR. BONNIE-KIM WAITE
Role:
PROVIDER
Phone:

Taxonomy:

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

Contacts:

Fax:
2083427042
Fax:
2083435031

Filing

Filing Name Filing Number Filing date
Annual Report 0005877775 2024-09-03
Annual Report 0005398938 2023-09-12
Annual Report 0004884349 2022-09-06
Annual Report 0004392793 2021-08-25
Annual Report 0003995627 2020-09-03

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Date of last update: 12 May 2025

Sources: Idaho Secretary of State