Healthcare Provider Details

I. General information

NPI: 1053360065
Provider Name (Legal Business Name): TREASURE VALLEY EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 12TH AVE RD
NAMPA ID
83686-6008
US

IV. Provider business mailing address

PO BOX 13309
PHILADELPHIA PA
19101-3309
US

V. Phone/Fax

Practice location:
  • Phone: 208-463-5100
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GATEWOOD
Title or Position: PRESIDENT
Credential:
Phone: 805-563-3011