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Greene Mountain Medical PLLC

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Company Details

Name: Greene Mountain Medical PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 14 Dec 2022 (2 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 5030660
Place of Formation: IDAHO
File Number: 853922
ZIP code: 83686
County: Canyon County
Principal Address: AIMEE SHEPARD 3719 WHEELER CIRCLE NAMPA, ID 83686
Mailing Address: AIMEE SHEPARD 3719 WHEELER CIR NAMPA, ID 83686-7949

Agent

Name Role Address
Aimee E. Shepard Agent 3719 WHEELER CIRCLE, NAMPA, ID 83686

Manager

Name Role Address Appointed On
Aimee E. Shepard Manager 3719 WHEELER CIRCLE, NAMPA, ID 83686 2023-12-04

National Provider Identifier

NPI Number:
1124710009
Certification Date:
2023-07-05

Authorized Person:

Name:
AIMEE ELIZABETH SHEPARD
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2086063682

Filing

Filing Name Filing Number Filing date
Annual Report 0005966978 2024-11-05
Annual Report 0005499739 2023-12-04
Initial Filing 0005030660 2022-12-14

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Date of last update: 26 Mar 2025

Sources: Idaho Secretary of State