Healthcare Provider Details

I. General information

NPI: 1841603768
Provider Name (Legal Business Name): TREASURE VALLEY FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 N STOKESBERRY PL
MERIDIAN ID
83646-5035
US

IV. Provider business mailing address

2428 N STOKESBERRY PL
MERIDIAN ID
83646-5035
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-0050
  • Fax: 855-543-3086
Mailing address:
  • Phone: 208-895-0050
  • Fax: 208-887-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberM11819
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN KEITH CROWNOVER
Title or Position: OWNER/PRESIDENT/PHYSICIAN
Credential: MD
Phone: 208-895-0050