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Magic Valley Sleep Institute LLC

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Company Details

Name: Magic Valley Sleep Institute LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 31 Jul 2003 (22 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 89237
Place of Formation: IDAHO
File Number: 89237
ZIP code: 83301
County: Twin Falls County
Principal Address: 775 POLE TWIN FALLS, ID 83301
Mailing Address: TROY MAHLKE STE 100 201 CANYON CREST DR TWIN FALLS, ID 83301-5935

Member

Name Role Address Appointed On
Brian W Fortuin MD PA Member 201 CANYON CREST DR W, TWIN FALLS, ID 83301-5935 2021-06-03
Richard Hammond Member 201 CANYON CREST DR W, TWIN FALLS, ID 83301-5935 2024-06-03

Agent

Name Role Address
BRIAN FORTUIN Agent 201 CANYON CREST DR # 100, TROY MAHLKE, TWIN FALLS, ID 83301

National Provider Identifier

NPI Number:
1992494389
Certification Date:
2023-09-26

Authorized Person:

Name:
BRIAN FORTUIN
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207RS0012X - Sleep Medicine (Internal Medicine) Physician
Is Primary:
Yes

Contacts:

Fax:
8558980004

Filing

Filing Name Filing Number Filing date
Annual Report 0005755039 2024-06-03
Annual Report 0005265367 2023-06-05
Annual Report 0004771970 2022-06-06
Annual Report 0004302159 2021-06-03
Annual Report 0003900111 2020-06-04

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Date of last update: 26 May 2025

Sources: Idaho Secretary of State