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Mountain State Breast and General Surgery, PLLC

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Company Details

Name: Mountain State Breast and General Surgery, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 12 Feb 2023 (2 years ago)
Financial Date End: 28 Feb 2025
Entity Number: 5113220
Place of Formation: IDAHO
File Number: 863519
ZIP code: 83705
County: Ada County
Principal Address: DR. MENEN 1525 S. OWYHEE STREET BOISE, ID 83705
Mailing Address: DR. MENEN 1525 S OWYHEE ST BOISE, ID 83705-6014

Agent

Name Role Address
Ryan Shackelford Agent 1525 S OWYHEE STREET, BOISE, ID 83705

Member

Name Role Address Appointed On
Ryan Shackelford Member 1525 S. OWYHEE STREET, BOISE, ID 83705 2024-03-04

Manager

Name Role Address Appointed On
Rhiana Menen Manager 1525 S. OWYHEE STREET, BOISE, ID 83705 2024-03-04

National Provider Identifier

NPI Number:
1720776164
Certification Date:
2024-01-18

Authorized Person:

Name:
DR. RHIANA S MENEN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005629792 2024-03-04
Initial Filing 0005113220 2023-02-12

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Date of last update: 02 Mar 2025

Sources: Idaho Secretary of State