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MEADOW LAKE SURGERY CENTER, INC.

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Company Details

Name: MEADOW LAKE SURGERY CENTER, INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 19 Apr 2006 (19 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 504572
Place of Formation: IDAHO
File Number: 504572
ZIP code: 83642
County: Ada County
Mailing Address: KIM WIGOD STE 200 3630 E LOUISE DR MERIDIAN, ID 83642-7975

Agent

Name Role Address
MARK K WIGOD Agent 7157 N SPURWING WAY, MERIDIAN, ID 83646

President

Name Role Address Appointed On
Mark D Wigod MD President 7157 N SPURWING WAY, MERIDIAN, ID 83646 2021-03-16

Secretary

Name Role Address Appointed On Resigned On
Kimberly M Wigod Secretary 7157 N SPURWING WAY, MERIDIAN, ID 83646 2024-03-13 2024-03-13

National Provider Identifier

NPI Number:
1740479476

Authorized Person:

Name:
MARK D WIGOD
Role:
M.D.
Phone:

Taxonomy:

Selected Taxonomy:
261QA1903X - Ambulatory Surgical Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2083779517

Filing

Filing Name Filing Number Filing date
Annual Report 0006158494 2025-03-12
Annual Report 0005646485 2024-03-13
Annual Report 0005155803 2023-03-14
Annual Report 0004659258 2022-03-14
Annual Report 0004211267 2021-03-16

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Date of last update: 02 Jul 2025

Sources: Idaho Secretary of State