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TABLE ROCK MOBILE MEDICINE, PLLC

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Company Details

Name: TABLE ROCK MOBILE MEDICINE, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 11 Mar 2016 (9 years ago)
Financial Date End: 31 Mar 2025
Date dissolved: 07 Jun 2025
Entity Number: 496671
Place of Formation: IDAHO
File Number: 496671
Principal Address: PO BOX 44953 BOISE, ID 83711
Mailing Address: PO BOX 44953 BOISE, ID 83711-0953

Manager

Name Role Address Appointed On
Bradley A Bigford Manager 1111 S ORCHARD ST, BOISE, ID 83705 2021-03-03

Agent

Name Role Address
BRADLEY BIGFORD Agent 3090 E GENTRY WAY, STE 210, TABLE ROCK MOBILE MEDICINE, MERIDIAN, ID 83642

Unique Entity ID

Unique Entity ID:
UTVLATEVCJK3
CAGE Code:
96LS4
UEI Expiration Date:
2025-01-29

Business Information

Activation Date:
2024-02-01
Initial Registration Date:
2021-10-13

National Provider Identifier

NPI Number:
1194186437
Certification Date:
2024-05-11

Authorized Person:

Name:
BRADLEY BIGFORD
Role:
SOLE MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2085042821
Fax:
8442687286

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0006303794 2025-06-07
Annual Report 0005631627 2024-03-04
Annual Report 0005242322 2023-05-15
Application for Reinstatement 0004853198 2022-08-08
Dissolution/Revocation - Administrative 0004791345 2022-06-24

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Date of last update: 02 Jul 2025

Sources: Idaho Secretary of State