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ORTHOIDAHO LLC

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Company Details

Name: ORTHOIDAHO LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 15 May 2017 (8 years ago)
Financial Date End: 31 May 2026
Entity Number: 554142
Place of Formation: IDAHO
File Number: 554142
ZIP code: 83201
County: Bannock County
Principal Address: 2240 E CENTER ST POCATELLO, ID 83201
Mailing Address: 2240 E CENTER ST POCATELLO, ID 83201-2600

Agent

Name Role Address
RICHARD A WATHNE, MD Agent 2240 E CENTER ST, POCATELLO, ID 83201

Member

Name Role Address Appointed On Resigned On
Anthony E Joseph Member 2240 E CENTER ST, POCATELLO, ID 83201 2024-04-29 2024-04-29
Richard A Wathne Member 2240 E. CENTER ST, POCATELLO, ID 83201 2024-04-29 2024-04-29

Manager

Name Role Address Appointed On
Benjamin Blair Manager 2240 E CENTER ST, POCATELLO, ID 83201 2021-04-08

National Provider Identifier

NPI Number:
1659870517

Authorized Person:

Name:
REBECCA J SMITH
Role:
PRACTICE ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
207XS0117X - Orthopaedic Surgery of the Spine Physician
Is Primary:
No
Selected Taxonomy:
207XX0005X - Sports Medicine (Orthopaedic Surgery) Physician
Is Primary:
No
Selected Taxonomy:
213ES0103X - Foot & Ankle Surgery Podiatrist
Is Primary:
No
Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2082333146

Filing

Filing Name Filing Number Filing date
Annual Report 0006204858 2025-04-11
Annual Report 0005706772 2024-04-29
Annual Report 0005267457 2023-06-05
Annual Report 0004767554 2022-06-03
Annual Report 0004242067 2021-04-08

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:
346300.00
Total Face Value Of Loan:
346300.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
346300
Current Approval Amount:
346300
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
350284.82

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Date of last update: 14 May 2025

Sources: Idaho Secretary of State