Healthcare Provider Details

I. General information

NPI: 1578826194
Provider Name (Legal Business Name): TREASURE VALLEY SURGICAL ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PEASLEY ST
BOISE ID
83705-1641
US

IV. Provider business mailing address

128 PEASLEY ST
BOISE ID
83705-1641
US

V. Phone/Fax

Practice location:
  • Phone: 208-861-3509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: HEIDI PROPST
Title or Position: CSA
Credential:
Phone: 208-861-3509