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KELLER SKIN & CANCER CARE PC

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Company Details

Name: KELLER SKIN & CANCER CARE PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 18 Jan 2012 (14 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 583806
Place of Formation: IDAHO
File Number: 583806
ZIP code: 83616
County: Ada County
Mailing Address: 1605 E RIVERSIDE DR EAGLE, ID 83616-6237

Agent

Name Role Address
WADE R KELLER DO Agent 1605 E RIVERSIDE DR, EAGLE, ID 83616

President

Name Role Address Appointed On
Wade R Keller President 193 W RIVER TRAIL DR, EAGLE, ID 83616 2020-12-09

National Provider Identifier

NPI Number:
1649543323
Certification Date:
2022-11-03

Authorized Person:

Name:
DR. WADE ROBERT KELLER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
No
Selected Taxonomy:
207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary:
No
Selected Taxonomy:
207NS0135X - Procedural Dermatology Physician
Is Primary:
No
Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
2089396442

Filing

Filing Name Filing Number Filing date
Annual Report 0005999729 2024-12-03
Annual Report 0005507178 2023-12-11
Annual Report 0005013000 2022-12-05
Annual Report 0004530768 2021-12-15
Annual Report 0004095663 2020-12-09

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:
172100.00
Total Face Value Of Loan:
172100.00
Date:
2016-10-18
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE
Obligated Amount:
0.00
Face Value Of Loan:
1620100.00
Total Face Value Of Loan:
1755800.00

Paycheck Protection Program

Jobs Reported:
17
Initial Approval Amount:
$172,100
Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$172,100
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$173,354.21
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $129,075
Utilities: $21,512.5
Mortgage Interest: $21,512.5

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Date of last update: 04 Jul 2025

Sources: Idaho Secretary of State