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  5. BOISE SHOULDER CLINIC, P.A.

BOISE SHOULDER CLINIC, P.A.

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Company Details

Name: BOISE SHOULDER CLINIC, P.A.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 19 Sep 2006 (19 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 512185
Place of Formation: IDAHO
File Number: 512185
ZIP code: 83616
County: Ada County
Mailing Address: 3381 W BAVARIA ST EAGLE, ID 83616-5341

Agent

Name Role Address
Carl S Humphrey Agent 1805 W SPANISH BAY DR, EAGLE, ID 83616

President

Name Role Address Appointed On Resigned On
Carl Scott Humphrey President 3381 W BAVARIA ST, EAGLE, ID 83616 2020-08-21 2023-08-03

Secretary

Name Role Address Appointed On
Carrie Humphrey Secretary 1805 W SPANISH BAY DR, EAGLE, ID 83616 2023-08-03

Director

Name Role Address Appointed On
Carl Scott Humphrey Director 1805 W SPANISH BAY DR, EAGLE, ID 83616 2023-08-03

Unique Entity ID

CAGE Code:
7GJL9
UEI Expiration Date:
2021-03-10

Business Information

Activation Date:
2020-03-10
Initial Registration Date:
2015-08-28

Commercial and government entity program

CAGE number:
7GJL9
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2023-11-28
CAGE Expiration:
2027-12-15
SAM Expiration:
2023-11-28

Contact Information

POC:
CARL HUMPHREY

National Provider Identifier

NPI Number:
1760581409
Link:
View on NPI website

Authorized Person:

Name:
DR. CARL SCOTT HUMPHREY
Role:
OWNER
Phone:
2086394800

Taxonomy:

Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Phone:
+1 208-639-4800
Fax:
2086394801

Form 5500 Series

Employer Identification Number (EIN):
205570411
Plan Year:
2023
Number Of Participants:
3
Sponsors Telephone Number:
2086394800
File:
View File
Plan Year:
2022
Number Of Participants:
3
Sponsors Telephone Number:
2086394800
File:
View File

Filing

Filing Name Filing Number Filing date
Annual Report 0005837469 2024-08-03
Annual Report Amendment 0005579275 2024-02-02
Annual Report 0005343004 2023-08-03
Change of Registered Office/Agent/Both (by Entity) 0004949269 2022-10-11
Annual Report 0004859789 2022-08-12

USAspending Awards / Contracts

Procurement Instrument Identifier:
36C26023P0169
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
PURCHASE ORDER
Action Obligation:
18178.48
Base And Exercised Options Value:
18178.48
Base And All Options Value:
18178.48
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2022-04-04
Description:
RATIFICATION / BOISE SHOULDER CLINIC / ORTHOPEDIC SURGEON
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q513: MEDICAL- ORTHOPEDIC
Procurement Instrument Identifier:
36C26022N0062
Link:
View Award on USAspending website
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
-49654.33
Base And Exercised Options Value:
-49654.33
Base And All Options Value:
-49654.33
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2021-10-01
Description:
ORTHOPEDIC SHOULDER SURGEON SERVICES
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q513: MEDICAL- ORTHOPEDIC
Procurement Instrument Identifier:
36C26021D0019
Link:
View Award on USAspending website
Award Or Idv Flag:
IDV
Action Obligation:
0.00
Base And All Options Value:
0.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2021-04-01
Description:
ORTHOPEDIC SHOULDER SURGEON SERVICES
Naics Code:
621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product Or Service Code:
Q513: MEDICAL- ORTHOPEDIC

USAspending Awards / Financial Assistance

Date:
2020-04-11
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
82345.00
Total Face Value Of Loan:
82345.00
Date:
2011-08-05
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO ASSIST SMALL BUSINESS CONCERNS BY PROVIDING LONG TERM FINANCING THROUGH THE SALE OF DEBENTURES TO THE PRIVATE SECTOR
Obligated Amount:
0.00
Face Value Of Loan:
-16000.00
Total Face Value Of Loan:
207000.00

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$82,345
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$82,345
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$82,963.15
Servicing Lender:
First Interstate Bank
Use of Proceeds:
Payroll: $82,345

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Related by address

3381 W BAVARIA ST EAGLE, ID 83616-5341

IDAHO SHOULDER EDUCATION AND RESEARCH FOUNDATION, INC.

Date of last update: 03 Jul 2025

Sources: Idaho Secretary of State

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