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MOSCOW MOUNTAIN ANESTHESIA PLLC

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Company Details

Name: MOSCOW MOUNTAIN ANESTHESIA PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 06 Apr 2017 (8 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 548522
Place of Formation: IDAHO
File Number: 548522
ZIP code: 83843
County: Latah County
Principal Address: 2300 WEST A ST MOSCOW, ID 83843
Mailing Address: 2300 W A ST MOSCOW, ID 83843-4038

Agent

Name Role Address
Edward R Winterbottom Agent 2364 HENRY CT, MOSCOW, ID 83843

Manager

Name Role Address Appointed On Resigned On
Robert S Smith Manager 2300 W A ST, MOSCOW, ID 83843 2021-03-03 2024-06-25
Edward R Winterbottom Manager 2364 HENRY CT, MOSCOW, ID 83843 2024-06-25 No data

Member

Name Role Address Appointed On
Robert Ellison Member 2300 W A ST,, MOSCOW, ID 83843 2024-06-25

National Provider Identifier

NPI Number:
1275074486
Certification Date:
2024-02-13

Authorized Person:

Name:
EDWARD WINTERBOTTOM
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
367500000X - Certified Registered Nurse Anesthetist
Is Primary:
Yes

Contacts:

Fax:
2088827701

Filing

Filing Name Filing Number Filing date
Annual Report 0006229170 2025-05-03
Annual Report 0005787941 2024-06-25
Change of Registered Office/Agent/Both (by Entity) 0005151219 2023-03-09
Annual Report 0005151220 2023-03-09
Annual Report 0004628338 2022-03-03

USAspending Awards / Financial Assistance

Date:
2020-04-28
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:
62500.00
Total Face Value Of Loan:
62500.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
62500
Current Approval Amount:
62500
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
62933.22

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Date of last update: 14 May 2025

Sources: Idaho Secretary of State