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Grange Surgery Center, PLLC

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Company Details

Name: Grange Surgery Center, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Oct 2022 (3 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 4947515
Place of Formation: IDAHO
File Number: 844542
ZIP code: 83616
County: Ada County
Principal Address: SUITE 250 450 W STATE ST EAGLE, ID 83616
Mailing Address: STE 250 450 W STATE ST EAGLE, ID 83616-6974

Agent

Name Role Address
LANDON K GRANGE Agent 450 W STATE ST, SUITE 250, EAGLE, ID 83616

Manager

Name Role Address Appointed On
Landon K Grange Manager 450 W STATE ST, EAGLE, ID 83616 2024-09-03

National Provider Identifier

NPI Number:
1316663032
Certification Date:
2023-08-22

Authorized Person:

Name:
LANDON GRANGE
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QS0132X - Ophthalmologic Surgery Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005878720 2024-09-03
Application for Reinstatement 0005557521 2024-01-10
Dissolution/Revocation - Administrative 0005555849 2024-01-10
Initial Filing 0004947515 2022-10-08

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Date of last update: 10 Jul 2025

Sources: Idaho Secretary of State