Healthcare Provider Details

I. General information

NPI: 1033117460
Provider Name (Legal Business Name): TREASURE VALLEY HEARING AND BALANCE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 N COLE RD
BOISE ID
83704-8642
US

IV. Provider business mailing address

1084 N COLE RD
BOISE ID
83704-8642
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-0019
  • Fax: 208-377-0313
Mailing address:
  • Phone: 208-377-0019
  • Fax: 208-377-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: JACQUIE ANNE ELCOX
Title or Position: OWNER PRESIDENT
Credential: BC-HIS
Phone: 208-377-0019