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Clark Family Medicine PLLC

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Company Details

Name: Clark Family Medicine PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 31 Mar 2023 (2 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 5172847
Place of Formation: IDAHO
File Number: 871789
ZIP code: 83201
County: Bannock County
Principal Address: 2445 GREENFIELD POCATELLO, ID 83201
Mailing Address: SHARLA CLARK 1246 YELLOWSTONE AVE SUITE A2 POCATELLO, ID 83201

Agent

Name Role Address
Sharla Clark Agent 2445 GREENFIELD, POCATELLO, ID 83201

Manager

Name Role Address Appointed On
Sharla Clark Manager 2445 GREENFIELD, POCATELLO, ID 83201 2024-02-14

National Provider Identifier

NPI Number:
1518740091
Certification Date:
2023-08-17

Authorized Person:

Name:
DR. SHARLA CLARK
Role:
OWNER/PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2084809590

Filing

Filing Name Filing Number Filing date
Annual Report 0006166355 2025-03-20
Annual Report 0005603703 2024-02-14
Initial Filing 0005172847 2023-03-31

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Date of last update: 20 Jun 2025

Sources: Idaho Secretary of State