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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: Active-Existing
Date of registration: 11 Mar 2016 (9 years ago)
Financial Date End: 31 Mar 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 PO BOX 44953, BOISE, ID 83711-0953 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

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

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
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
Annual Report 0004191326 2021-03-03

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Date of last update: 12 May 2025

Sources: Idaho Secretary of State