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PNW Medical Group, LLC

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Company Details

Name: PNW Medical Group, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 Dec 2024 (7 months ago)
Financial Date End: 31 Dec 2025
Entity Number: 6019747
Place of Formation: IDAHO
File Number: 967453
ZIP code: 83815
County: Kootenai County
Principal Address: 1940 E GUNTHER AVE COEUR D'ALENE, ID 83815
Mailing Address: 1940 E GUNTHER AVE COEUR D ALENE, ID 83815-9435

Agent

Name Role Address
Kyle Severinsen Agent 1940 E GUNTHER AVE, COEUR D'ALENE, ID 83815

National Provider Identifier

NPI Number:
1386457125
Certification Date:
2025-01-27

Authorized Person:

Name:
DR. KYLE SEVERINSEN
Role:
OWNER/CEO
Phone:

Taxonomy:

Selected Taxonomy:
208M00000X - Hospitalist Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006019747 2024-12-10

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State