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Treasure Valley Childrens Clinic, PC

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Company Details

Name: Treasure Valley Childrens Clinic, PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 25 Jan 2023 (2 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 5074687
Place of Formation: IDAHO
File Number: 859154
ZIP code: 83702
County: Ada County
Mailing Address: 1775 W STATE ST PMB 229 BOISE, ID 83702-3924

Agent

Name Role Address
Ayla Birch Agent 1220 N 11TH ST, BOISE, ID 83702

President

Name Role Address Appointed On
Brian Birch President 1775 W STATE ST, BOISE, ID 83702 2024-01-30

National Provider Identifier

NPI Number:
1366142127
Certification Date:
2023-03-08

Authorized Person:

Name:
DR. BRIAN BIRCH
Role:
PRESIDENT & CEO
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
2082030097

Filing

Filing Name Filing Number Filing date
Annual Report 0006065709 2025-01-11
Annual Report 0005575603 2024-01-30
Initial Filing 0005074687 2023-01-25

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Date of last update: 19 Jun 2025

Sources: Idaho Secretary of State