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BASIS INTERNAL MEDICINE, LLC

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Company Details

Name: BASIS INTERNAL MEDICINE, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Sep 2016 (9 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 522722
Place of Formation: IDAHO
File Number: 522722
Principal Address: 804 SW CAPRINGTON ST BENTONVILLE, AR 72712-4857

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

Manager

Name Role Address Appointed On Resigned On
Harry Andres Lazarte jr Manager 804 SW CAPRINGTON STREET, BENTONVILLE, AR 72712 2022-02-24 2022-09-08
Harry Andres Lazarte Manager 4105 HIGHPLAINS DRIVE, LITTLE FLOCK, AR 72756 2021-12-24 2022-02-24
Harry Lazarte Manager 1723 S GRAND FORK WAY, MERIDIAN, ID 83642 2021-01-15 2021-12-24
Harry A Lazarte jr Manager 804 SW CAPRINGTON STREET, BENTONVILLE, AR 72712 2020-08-17 No data
Harry andres lazarte jr Manager 804 SW CAPRINGTON STREET, BENTONVILLE, AR 72712 2024-08-03 No data

National Provider Identifier

NPI Number:
1306385950
Certification Date:
2021-03-24

Authorized Person:

Name:
HARRY A LAZARTE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
8669500277

Filing

Filing Name Filing Number Filing date
Annual Report 0005838437 2024-08-03
Change of Registered Office/Agent/Both (by Entity) 0005645582 2024-03-12
Application for Reinstatement 0005638534 2024-03-06
Dissolution/Revocation - Administrative 0005514275 2023-12-16
Annual Report 0004890079 2022-09-08

USAspending Awards / Financial Assistance

Date:
2020-06-01
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
5000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-05-28
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
5000.00
Total Face Value Of Loan:
5000.00
Date:
2020-04-14
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:
35800.00
Total Face Value Of Loan:
35800.00

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$35,800
Date Approved:
2020-04-14
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$35,800
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$36,327.68
Servicing Lender:
Zions Bank, A Division of
Use of Proceeds:
Payroll: $35,800

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Date of last update: 03 Jul 2025

Sources: Idaho Secretary of State