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Southern Idaho Wound Care, PLLC

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Company Details

Name: Southern Idaho Wound Care, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 30 Sep 2024 (8 months ago)
Financial Date End: 30 Sep 2025
Entity Number: 5914319
Place of Formation: IDAHO
File Number: 957327
ZIP code: 83442
County: Jefferson County
Principal Address: SOUTHERN IDAHO WOUND CARE 242 N 4200 E RIGBY, ID 83442
Mailing Address: KUSHAL DHESI PO BOX 575 LEWISBURG, PA 17837-0575

Agent

Name Role Address
SCOTT E MCKINLEY Agent 242 N 4200 E, RIGBY, ID 83442

National Provider Identifier

NPI Number:
1679382600
Certification Date:
2025-01-03

Authorized Person:

Name:
KUSHALJIT DHESI
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363A00000X - Physician Assistant
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0005914319 2024-09-30

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Date of last update: 23 May 2025

Sources: Idaho Secretary of State