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EXODUS PAIN CLINIC

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Company Details

Name: EXODUS PAIN CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Inactive-Cancelled
Date of registration: 02 Dec 2013 (12 years ago)
Entity Number: 507412
Place of Formation: IDAHO
File Number: 0000507412
ZIP code: 83702
County: Ada County
Mailing Address: 1775 STATE ST 163 BOISE, ID 83702

National Provider Identifier

NPI Number:
1366849572
Certification Date:
2023-06-22

Authorized Person:

Name:
DANIEL MARSH
Role:
MD/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2082977772

Filing

Filing Name Filing Number Filing date
Cancellation of Certificate of Assumed Business Name 0000918721 2016-05-06
Initial Filing 0000507412 2013-12-02

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State