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Christopher Vaughan, MD PLLC

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Company Details

Name: Christopher Vaughan, MD PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 Feb 2023 (2 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 5121447
Place of Formation: IDAHO
File Number: 865015
ZIP code: 83702
County: Ada County
Principal Address: 301 W MYRTLE BOISE, ID 83702
Mailing Address: 301 W MYRTLE ST BOISE, ID 83702-7656

Agent

Name Role Address
Christopher Vaughan Agent 301 W MYRTLE ST, BOISE, ID 83702-7656

Manager

Name Role Address Appointed On
Christopher Vaughan Manager 301 W MYRTLE ST, BOISE, ID 83702-7656 2024-03-28

National Provider Identifier

NPI Number:
1376244061
Certification Date:
2023-03-14

Authorized Person:

Name:
SHANA INGRAM
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary:
Yes

Contacts:

Fax:
2083428202

Filing

Filing Name Filing Number Filing date
Annual Report 0006153632 2025-03-10
Annual Report 0005661855 2024-03-28
Initial Filing 0005121447 2023-02-21

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Date of last update: 10 Jul 2025

Sources: Idaho Secretary of State