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Legacy Primary Care, LLC

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Company Details

Name: Legacy Primary Care, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Aug 2024 (a year ago)
Financial Date End: 31 Aug 2025
Entity Number: 5854510
Place of Formation: IDAHO
File Number: 949957
ZIP code: 83642
County: Ada County
Principal Address: 4103 E. FRATELLO ST MERIDIAN, ID 83642
Mailing Address: STE 120 2273 E GALA ST MERIDIAN, ID 83642-7289

Agent

Name Role Address
Cheryl Fish Agent 4103 E FRATELLO ST, MERIDIAN, ID 83642

National Provider Identifier

NPI Number:
1568289247
Certification Date:
2024-10-16

Authorized Person:

Name:
CHERYL FISH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Change of Business Mailing Address 0005942874 2024-10-16
Initial Filing 0005854510 2024-08-11

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Date of last update: 21 Jun 2025

Sources: Idaho Secretary of State