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SHOULDER CLINIC OF IDAHO, PLLC (THE)

SHOULDER CLINIC OF IDAHO, PLLC (THE)

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Company Details

Name:	SHOULDER CLINIC OF IDAHO, PLLC (THE)
Jurisdiction:	Idaho
Legal type:	Limited Liability Company (D)
Status:	Active-Existing
Date of registration:	18 Dec 2001 (24 years ago)
Financial Date End:	31 Dec 2025
Entity Number:	66067
Place of Formation:	IDAHO
File Number:	66067
ZIP code:	83704
County:	Ada County
Principal Address:	8854 W EMERALD ST STE 102 BOISE, ID 83704
Mailing Address:	STE 102 8854 W EMERALD ST BOISE, ID 83704-4845

Agent

Name	Role	Address
DAVID P MCANANEY	Agent	1101 W RIVER STREET STE 100, BOISE, ID 83702

Member

Name	Role	Address	Appointed On	Resigned On
Jared Johnson	Member	8854 W EMERALD STREET, BOISE, ID 83704	2023-11-07	2023-11-07
THOMAS CHOPP	Member	8854 W EMERALD STREET, BOISE, ID 83704	2023-11-07	2023-11-07
Joseph Lynch	Member	8854 W EMERALD STREET, BOISE, ID 83704	2020-11-09	No data

National Provider Identifier

NPI Number:

1821164138

Certification Date:

2023-03-14

Link:

View on NPI website

Authorized Person:

Name:

MR. THOMAS EARL GOODWIN

Role:

OWNER

Phone:

2083234747

Taxonomy:

Selected Taxonomy:

207X00000X - Orthopaedic Surgery Physician

Is Primary:

Yes

Contacts:

Phone:

+1 208-287-9420

Phone:

+1 208-323-4747

Fax:

2083234848

Form 5500 Series

Employer Identification Number (EIN):

820537848

Plan Year:

2018

Number Of Participants:

13

Sponsors Telephone Number:

2083234747

File:

Plan Year:

2017

Number Of Participants:

10

Sponsors Telephone Number:

2083234747

File:

Plan Year:

2016

Number Of Participants:

12

Sponsors Telephone Number:

2083234747

File:

Plan Year:

2015

Number Of Participants:

12

Sponsors Telephone Number:

2083234747

File:

Plan Year:

2014

Number Of Participants:

13

Sponsors Telephone Number:

2083449400

File:

Filing

Filing Name	Filing Number	Filing date
Annual Report	0005963779	2024-11-04
Annual Report	0005470401	2023-11-07
Annual Report	0004982713	2022-11-05
Annual Report	0004492884	2021-11-09
Annual Report	0004064048	2020-11-09

Paycheck Protection Program

Jobs Reported:

13

Initial Approval Amount:

$196,200

Date Approved:

2020-04-12

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$196,200

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$197,532.11

Servicing Lender:

First Interstate Bank

Use of Proceeds:

Payroll: $196,200

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Date of last update: 30 Jul 2025

Sources: Idaho Secretary of State