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First Care Concussion Diagnostic Clinics of Idaho LLC

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Company Details

Name: First Care Concussion Diagnostic Clinics of Idaho LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 27 Mar 2023 (2 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 5168400
Place of Formation: IDAHO
File Number: 870923
ZIP code: 83644
County: Canyon County
Principal Address: 24641 BLAZE AVE MIDDLETON, ID 83644
Mailing Address: STE 417 9601 PULASKI PARK DR BALTIMORE, MD 21220-1409

Member

Name Role Address Appointed On
Terry Willardson Member 24641 BLAZE AVE, MIDDLETON, ID 83644 2024-05-30
Nate Miller Member 24641 BLAZE AVE, MIDDLETON, ID 83644 2024-05-30

Agent

Name Role Address
REGISTERED AGENTS INC Agent 784 S CLEARWATER LOOP STE R, POST FALLS, ID 83854

Manager

Name Role Address Appointed On
Advanced Medical Management, LLC Manager 9601 PULASKI PARK DR, BALTIMORE, MD 21220-1409 2025-05-19

National Provider Identifier

NPI Number:
1609563618
Certification Date:
2023-04-19

Authorized Person:

Name:
DR. NATHAN DEE MILLER
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
261QH0100X - Health Service Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3853655054

Filing

Filing Name Filing Number Filing date
Annual Report Amendment 0006259434 2025-05-19
Change of Registered Office/Agent/Both (by Entity) 0006198937 2025-04-21
Annual Report 0006141519 2025-03-04
Annual Report 0005751560 2024-05-30
Initial Filing 0005168400 2023-03-27

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Date of last update: 25 Jul 2025

Sources: Idaho Secretary of State