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INTERMOUNTAIN AMBULATORY ANESTHESIA PLLC

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Company Details

Name: INTERMOUNTAIN AMBULATORY ANESTHESIA PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Apr 2001 (24 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 59396
Place of Formation: IDAHO
File Number: 59396
ZIP code: 83642
County: Ada County
Principal Address: IAA, KIRK MILLER MD 875 SOUTH VANGUARD WAY, SUITE 120 MERIDIAN, ID 83642
Mailing Address: IAA, KIRK MILLER MD STE 120 875 S VANGUARD WAY MERIDIAN, ID 83642-8541

Agent

Name Role Address
KIRK A MILLER MD Agent 1417 N 19TH ST, BOISE, ID 83702

Manager

Name Role Address Appointed On
KIRK MILLER Manager 1417 N 19TH ST, BOISE, ID 83702 2021-03-03

Member

Name Role Address Appointed On Resigned On
RYAN JENSEN Member 1766 N HIGHBURY WAY, EAGLE, ID 83616 2024-03-04 2024-03-04
NATE RAWLINS Member 5472 S MCCURRY WAY, MERIDIAN, ID 83642 2024-03-04 2024-03-04
Cory Lewis Member 875 S VANGUARD WAY STE 120, MERIDIAN, ID 83642 2024-03-04 No data
JAMES ERNEST Member 15576 TOSCANO PLACE, CALDWELL, ID 83607 2024-03-04 2024-03-04
Jeanne DeBarto Member 875 S VANGUARD WAY STE 120, MERIDIAN, ID 83642 2024-03-04 No data

National Provider Identifier

NPI Number:
1073546289
Certification Date:
2022-02-23

Authorized Person:

Name:
DR. KIRK MILLER
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
207L00000X - Anesthesiology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
522314761
Plan Year:
2023
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
3
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006138175 2025-03-03
Annual Report 0005633061 2024-03-04
Annual Report 0005154727 2023-03-13
Annual Report 0004632655 2022-03-03
Amendment to Certificate 0004414384 2021-09-10

USAspending Awards / Financial Assistance

Date:
2020-04-13
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:
90000.00
Total Face Value Of Loan:
90000.00

Paycheck Protection Program

Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
90000
Current Approval Amount:
90000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
91060.27

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Date of last update: 23 Jun 2025

Sources: Idaho Secretary of State