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Creswell Foot & Ankle Surgery PLLC

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Company Details

Name: Creswell Foot & Ankle Surgery PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 06 Mar 2024 (a year ago)
Financial Date End: 31 Mar 2026
Entity Number: 5657310
Place of Formation: IDAHO
File Number: 928059
ZIP code: 83839
County: Shoshone County
Principal Address: 858 COMMERCE DR STE 101 SMELTERVILLE, ID 83839
Mailing Address: PO BOX 483 SMELTERVILLE, ID 83868-0483

Agent

Name Role Address
DALON ESPLIN Agent 186 E JUDICIAL ST, BLACKFOOT, ID 83221

Managing Member

Name Role Address Appointed On
JOSEPH A. CRESWELL Managing Member 858 COMMERCE DRIVE, SMELTERVILLE, ID 83868 2025-03-03

National Provider Identifier

NPI Number:
1699508929
Certification Date:
2024-08-20

Authorized Person:

Name:
JIMMY PRICE
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
213E00000X - Podiatrist
Is Primary:
Yes

Contacts:

Fax:
2087848777
Fax:
2087843533

Filing

Filing Name Filing Number Filing date
Annual Report 0006136527 2025-03-03
Initial Filing 0005657310 2024-03-06

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State