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EASTERN IDAHO FOOT CLINIC

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Company Details

Name: EASTERN IDAHO FOOT CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 14 Sep 2015 (10 years ago)
Entity Number: 548577
Place of Formation: IDAHO
File Number: 0000548577
ZIP code: 83406
County: Bonneville County
Mailing Address: 2325 CORONADO ST IDAHO FALLS, ID 83406

National Provider Identifier

NPI Number:
1225365992

Authorized Person:

Name:
DR. JERRY D. COOPER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
Yes

Contacts:

Fax:
2085232962

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000928687 2016-09-28
Initial Filing 0000548577 2015-09-14

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State