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Momentum Medical Group of Idaho, LLC

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Company Details

Name: Momentum Medical Group of Idaho, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 26 Sep 2023 (2 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 5411326
Place of Formation: IDAHO
File Number: 900168
ZIP code: 83704
County: Ada County
Principal Address: SUITE 140 8854 W EMERALD ST BOISE, ID 83704
Mailing Address: STE 140 8854 W EMERALD ST BOISE, ID 83704-4845

Agent

Name Role Address
NANCY DIANE POWELL Agent 690 W RIODOSA DR, MERIDIAN, ID 83642

Member

Name Role Address Appointed On
Jeffrey G Hessing Member 6748 N DOUBLE EAGLE, MERIDIAN, ID 83646 2024-09-09

National Provider Identifier

NPI Number:
1417737594
Certification Date:
2024-01-10

Authorized Person:

Name:
HEATHER BEARD
Role:
BILLING SERVICE
Phone:

Taxonomy:

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

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
933560965
Plan Year:
2023
Number Of Participants:
0
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005894188 2024-09-09
Amendment to Certificate 0005505680 2023-12-08
Initial Filing 0005411326 2023-09-26

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Date of last update: 21 May 2025

Sources: Idaho Secretary of State