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PHS Ambulatory Services, LLC

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Company Details

Name: PHS Ambulatory Services, LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Inactive-Revoked (Administrative)
Date of registration: 06 Jul 2023 (2 years ago)
Financial Date End: 31 Jul 2024
Date dissolved: 11 Oct 2024
Entity Number: 5317452
Place of Formation: DELAWARE
File Number: 888132
ZIP code: 83201
County: Bannock County
Principal Address: 2850 OLYMPUS DR POCATELLO, ID 83201-2271
Mailing Address: STE 100 340 SEVEN SPRINGS WAY BRENTWOOD, TN 37027-5697

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 1305 12TH AVE RD, NAMPA, ID 83686

National Provider Identifier

NPI Number:
1306524152
Certification Date:
2023-10-03

Authorized Person:

Name:
STEPHEN PETROVICH
Role:
EVP GENERAL COUNSEL
Phone:

Taxonomy:

Selected Taxonomy:
261QU0200X - Urgent Care Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005937893 2024-10-11
Initial Filing 0005317452 2023-07-06

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Date of last update: 20 Jun 2025

Sources: Idaho Secretary of State