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REVOLUTIONARY MEDICINE OF IDAHO PLLC

Company Details

Name: REVOLUTIONARY MEDICINE OF IDAHO PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 20 Mar 2024 (a year ago)
Financial Date End: 31 Mar 2026
Entity Number: 5655116
Place of Formation: IDAHO
File Number: 927603
ZIP code: 83641
County: Owyhee County
Principal Address: 2536 CANYON RD SO MELBA, ID 83641
Mailing Address: 2536 CANYON RD S MELBA, ID 83641-5258

Agent

Name Role Address
LORNA R MARVIN Agent 3936 DUNDEE DR, NEW PLYMOUTH, ID 83655

Manager

Name Role Address Appointed On
JEFFREY D ROBBINS Manager 2536 CANYON RD S, MELBA, ID 83641 2025-02-13

National Provider Identifier

NPI Number:
1487493292
Certification Date:
2024-05-21

Authorized Person:

Name:
MR. JEFFREY D ROBBINS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2086589501

Filing

Filing Name Filing Number Filing date
Annual Report 0006108133 2025-02-13
Initial Filing 0005655116 2024-03-20

Date of last update: 22 May 2025

Sources: Idaho Secretary of State