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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

Authorized Person:

Name:
MR. THOMAS EARL GOODWIN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2083234848

Form 5500 Series

Employer Identification Number (EIN):
820537848
Plan Year:
2018
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
13
Sponsors Telephone Number:

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