Healthcare Provider Details

I. General information

NPI: 1215992003
Provider Name (Legal Business Name): TREASURE VALLEY ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914
US

IV. Provider business mailing address

24442 NUBIAN GOAT CT
CALDWELL ID
83607-8525
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7140
  • Fax:
Mailing address:
  • Phone: 208-604-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: COLE R SHAWVER
Title or Position: PRESIDENT
Credential: CRNA
Phone: 208-604-0348