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Southern Idaho Medicine PLLC

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Company Details

Name: Southern Idaho Medicine PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 17 Dec 2022 (3 years ago)
Financial Date End: 31 Dec 2023
Date dissolved: 07 May 2023
Entity Number: 5032764
Place of Formation: IDAHO
File Number: 854263
ZIP code: 83338
County: Jerome County
Principal Address: JESSIE CRISMOR 207 E MAIN STREET JEROME, ID 83338
Mailing Address: JESSIE CRISMOR 137 WOODRIDGE DR TWIN FALLS, ID 83301-8156

Agent

Name Role Address
Jessicca Marie Crismor Agent 137 WOODRIDGE DRIVE, TWIN FALLS, ID 83301

National Provider Identifier

NPI Number:
1861105694
Certification Date:
2022-12-25

Authorized Person:

Name:
JESSICCA MARIE CRISMOR
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0005231947 2023-05-07
Initial Filing 0005032764 2022-12-17

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Date of last update: 19 Jun 2025

Sources: Idaho Secretary of State