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CAROL KLETT VANCE M.D., INC.

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Company Details

Name: CAROL KLETT VANCE M.D., INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 01 Feb 2008 (17 years ago)
Financial Date End: 28 Feb 2022
Date dissolved: 17 May 2022
Entity Number: 535611
Place of Formation: IDAHO
File Number: 535611
ZIP code: 83406
County: Bonneville County
Mailing Address: STE 6 1619 CURLEW DR AMMON, ID 83406-4719

Agent

Name Role Address
CAROL KLETT VANCE Agent 1619 CURLEW DR STE 6, IDAHO FALLS, ID 83406

President

Name Role Address Appointed On
Carol Vance MD President 1619 CURLEW DR, AMMON, ID 83406 2021-02-23

National Provider Identifier

NPI Number:
1346410321

Authorized Person:

Name:
CAROL KLETT VANCE
Role:
PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
2080P0008X - Pediatric Neurodevelopmental Disabilities Physician
Is Primary:
Yes

Contacts:

Fax:
2085234990

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004749542 2022-05-17
Annual Report 0004181544 2021-02-23
Annual Report 0003784853 2020-02-19
Application for Reinstatement 0003550469 2019-06-24
Dissolution/Revocation - Administrative 0003544241 2019-06-18

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Date of last update: 03 Jul 2025

Sources: Idaho Secretary of State