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MICHAEL R. DIBENEDETTO, M.D., PLLC

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Company Details

Name: MICHAEL R. DIBENEDETTO, M.D., PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Aug 2002 (23 years ago)
Financial Date End: 31 Aug 2026
Entity Number: 74829
Place of Formation: IDAHO
File Number: 74829
ZIP code: 83852
County: Bonner County
Principal Address: 30544 HWY 200 STE 102 PONDERAY, ID 83852
Mailing Address: STE 102 30544 HIGHWAY 200 PONDERAY, ID 83852-5005

Agent

Name Role Address
MICHAEL R DIBENEDETTO Agent 30544 HWY 200, STE 102, PONDERAY, ID 83852

Manager

Name Role Address Appointed On Resigned On
Michael DiBenedetto Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852 2020-09-10 No data
Travis Taylor Manager 30544 HWY 200, PONDERAY, ID 83852 2023-08-01 2024-08-01
Joan Bloom Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852-5005 2023-08-01 2024-08-01
Michael Schicker Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852-5005 2023-08-01 2024-08-01
JONATHAN FISHER Manager 30544 HWY 200, STE 102, SANDPOINT, ID 83864 2023-08-01 2024-08-01

National Provider Identifier

NPI Number:
1073757464

Authorized Person:

Name:
WENDY S BROSNAHAN
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
2086S0122X - Plastic and Reconstructive Surgery Physician
Is Primary:
Yes

Contacts:

Fax:
2082631319

Form 5500 Series

Employer Identification Number (EIN):
753077363
Plan Year:
2024
Number Of Participants:
47
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
41
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
39
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
38
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
37
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006369686 2025-07-24
Annual Report 0005835127 2024-08-01
Annual Report 0005336642 2023-08-01
Annual Report 0004834702 2022-07-29
Annual Report 0004428474 2021-09-27

USAspending Awards / Financial Assistance

Date:
2020-05-27
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:
62500.00
Total Face Value Of Loan:
312496.85

Paycheck Protection Program

Jobs Reported:
21
Initial Approval Amount:
$249,996.85
Date Approved:
2020-04-10
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$312,496.85
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Veteran
Forgiveness Amount:
$314,611.55
Servicing Lender:
Glacier Bank
Use of Proceeds:
Payroll: $312,496.85

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Date of last update: 27 Aug 2025

Sources: Idaho Secretary of State