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INTERMOUNTAIN REGENERATIVE MEDICINE, LLC

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Company Details

Name: INTERMOUNTAIN REGENERATIVE MEDICINE, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 26 Feb 2018 (7 years ago)
Financial Date End: 28 Feb 2025
Date dissolved: 13 May 2025
Entity Number: 596207
Place of Formation: IDAHO
File Number: 596207
ZIP code: 83404
County: Bonneville County
Principal Address: 1515 ASHMENT AVE IDAHO FALLS, ID 83404-5745
Mailing Address: 3829 FOUNDERS POINTE DR AMMON, ID 83406-5104

Agent

Name Role Address
BRADY WIRICK Agent 3829 FOUNDERS POINTE DR, AMMON, ID 83406

Manager

Name Role Address Appointed On Resigned On
Kim Graham Manager 3829 FOUNDERS POINTE DR, IDAHO FALLS, ID 83406 2022-05-25 No data
Brady Wirick Manager 3829 FOUNDERS POINTE DR, AMMON, ID 83406 2021-09-07 2022-05-25

National Provider Identifier

NPI Number:
1922731827
Certification Date:
2023-12-07

Authorized Person:

Name:
MARIE BARRS
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0006250540 2025-05-13
Application for Reinstatement 0005861274 2024-08-14
Dissolution/Revocation - Administrative 0005726683 2024-05-07
Annual Report 0005045616 2023-01-03
Application for Reinstatement 0004751685 2022-05-25

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Date of last update: 05 Jul 2025

Sources: Idaho Secretary of State