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FUNCTIONAL MEDICINE OF IDAHO INC.

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Company Details

Name: FUNCTIONAL MEDICINE OF IDAHO INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 12 Dec 2017 (7 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 633567
Place of Formation: IDAHO
File Number: 633567
ZIP code: 83642
County: Ada County
Mailing Address: 2939 W EXCURSION LN MERIDIAN, ID 83642-5308

Agent

Name Role Address
Exceed Corporate Services LLC Agent 421 S 8TH STREET, BOISE, ID 83702

President

Name Role Address Appointed On Resigned On
SAMUEL J WARREN President 745 S PROGRESS, MERIDIAN, ID 83642 2020-12-11 2022-01-28

Incorporator

Name Role Address Appointed On
Ian W Gee Incorporator 421 S. 8TH STREET, BOISE, ID 83702 2022-05-02

Director

Name Role Address Appointed On Resigned On
Sam Warren Director 2939 W. EXCURSION LN., MERIDIAN, ID 83642 2022-12-31 No data
Amber Warren Director 2939 W. EXCURSION LN., MERIDIAN, ID 83642 2024-01-01 2024-01-01

National Provider Identifier

NPI Number:
1336656040

Authorized Person:

Name:
SAMUEL JAMES WARREN
Role:
PRESIDENT
Phone:

Taxonomy:

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

Contacts:

Fax:
2083850346

Filing

Filing Name Filing Number Filing date
Annual Report 0006041651 2025-01-02
Annual Report 0005532031 2024-01-01
Annual Report 0005043027 2022-12-31
Statement of Conversion 0004712187 2022-05-02
Annual Report 0004584474 2022-01-28

USAspending Awards / Financial Assistance

Date:
2020-05-02
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:
9937.50
Total Face Value Of Loan:
274300.00

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Date of last update: 16 May 2025

Sources: Idaho Secretary of State