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Edge Medical PLLC

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Company Details

Name: Edge Medical PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Nov 2024 (7 months ago)
Financial Date End: 30 Nov 2025
Entity Number: 5988704
Place of Formation: IDAHO
File Number: 964657
ZIP code: 83642
County: Ada County
Principal Address: 2640 S EAGLE RD MERIDIAN, ID 83642
Mailing Address: 2640 S EAGLE RD MERIDIAN, ID 83642-6704

Agent

Name Role Address
Kathleen Nielsen Agent 2640 S EAGLE RD, MERIDIAN, ID 83642

National Provider Identifier

NPI Number:
1922814474
Certification Date:
2024-12-09

Authorized Person:

Name:
KATHLEEN NIELSEN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2088844794

Filing

Filing Name Filing Number Filing date
Initial Filing 0005988704 2024-11-19

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Date of last update: 23 May 2025

Sources: Idaho Secretary of State