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North Idaho Family Practice LLC

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Company Details

Name: North Idaho Family Practice LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 28 Jan 2025 (4 months ago)
Financial Date End: 31 Jan 2026
Entity Number: 6082921
Place of Formation: IDAHO
File Number: 975169
ZIP code: 83854
County: Kootenai County
Principal Address: STE B 1101 E POLSTON AVE POST FALLS, ID 83854
Mailing Address: 4200 E EVERGREEN DR POST FALLS, ID 83854-7722

Agent

Name Role Address
Nicholas Bozarth Agent 1101 E POLSTON AVE, STE B, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1780497859
Certification Date:
2025-03-10

Authorized Person:

Name:
NICHOLAS WADE BOZARTH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363AM0700X - Medical Physician Assistant
Is Primary:
Yes

Contacts:

Fax:
2087471777

Filing

Filing Name Filing Number Filing date
Initial Filing 0006082921 2025-01-28

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Date of last update: 30 Apr 2025

Sources: Idaho Secretary of State