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  5. MOUNTAIN WEST MEDICAL SERVICES, PLLC

MOUNTAIN WEST MEDICAL SERVICES, PLLC

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Company Details

Name: MOUNTAIN WEST MEDICAL SERVICES, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 14 Nov 2016 (9 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 527442
Place of Formation: IDAHO
File Number: 527442
ZIP code: 83642
County: Ada County
Principal Address: 1067 S WELLS ST STE 200 MERIDIAN, ID 83642
Mailing Address: STE 110 1067 S WELLS ST MERIDIAN, ID 83642-8598

Agent

Name Role Address
JOHN MCRAE Agent 1067 S WELLS ST STE 200, MERIDIAN, ID 83642

Member

Name Role Address Appointed On
John McRae Member 1067 S WELLS ST, MERIDIAN, ID 83642-7997 2021-02-09

National Provider Identifier

NPI Number:
1457894339
Certification Date:
2023-07-07
Link:
View on NPI website

Authorized Person:

Name:
DR. JOHN KENNETH MCRAE
Role:
DR. OF NURSE PRACTIONER
Phone:
2082298739

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Phone:
+1 208-229-8739
Fax:
2088958540

Filing

Filing Name Filing Number Filing date
Annual Report 0005931650 2024-10-07
Annual Report 0005432188 2023-10-05
Annual Report 0004967496 2022-11-02
Annual Report 0004582582 2022-01-27
Application for Reinstatement 0004169743 2021-02-09

USAspending Awards / Financial Assistance

Date:
2021-01-23
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:
20832.50
Total Face Value Of Loan:
20832.50
Date:
2020-05-12
Link:
View on USAspending
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:
66700.00
Total Face Value Of Loan:
356200.00
Date:
2020-04-29
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:
23342.20
Total Face Value Of Loan:
23342.20
Date:
2020-04-14
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
1000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Date Approved:
2020-04-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
23342.2
Current Approval Amount:
23342.2
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
23550.33
Date Approved:
2021-01-20
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
20832.5
Current Approval Amount:
20832.5
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Unanswered
Forgiveness Amount:
20930.67

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Date of last update: 07 Jun 2025

Sources: Idaho Secretary of State

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