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MOUNTAIN PINE DERMATOLOGY PLLC

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Company Details

Name: MOUNTAIN PINE DERMATOLOGY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Mar 2016 (9 years ago)
Financial Date End: 31 Mar 2026
Date dissolved: 12 Jun 2024
Entity Number: 494483
Place of Formation: IDAHO
File Number: 494483
ZIP code: 83646
County: Ada County
Mailing Address: STE 100 4664 N PENNGROVE WAY MERIDIAN, ID 83646-7442

Agent

Name Role Address
RICHARD SCOTT THOMAS Agent 4664 N PENNGROVE WAY, STE 100, MERIDIAN, ID 83646

Manager

Name Role Address Appointed On
Stefanie Thomas Manager 4664 N PENNGROVE WAY, MERIDIAN, ID 83646-7442 2020-08-11

National Provider Identifier

NPI Number:
1659827665
Certification Date:
2020-07-05

Authorized Person:

Name:
DR. RICHARD SCOTT THOMAS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
811701258
Plan Year:
2023
Number Of Participants:
50
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
53
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
37
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
27
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
16
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006198305 2025-04-07
Application for Reinstatement 0005933682 2024-10-08
Dissolution/Revocation - Administrative 0005774983 2024-06-12
Annual Report 0005154344 2023-03-13
Change of Registered Office/Agent/Both (by Entity) 0004591942 2022-02-03

USAspending Awards / Financial Assistance

Date:
2020-04-11
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:
215000.00
Total Face Value Of Loan:
215000.00
Date:
2019-11-20
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
3285000.00
Total Face Value Of Loan:
3285000.00
Date:
2016-03-31
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
200000.00
Total Face Value Of Loan:
200000.00

Paycheck Protection Program

Jobs Reported:
75
Initial Approval Amount:
$215,000
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$215,000
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$216,837.81
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $161,250
Utilities: $17,845
Mortgage Interest: $17,845
Healthcare: $18060

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Date of last update: 02 Jul 2025

Sources: Idaho Secretary of State