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General NPI Number Information
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NPI Number | 1164738134
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY SERVICE COORDINATION
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 1620 S CELEBRATION AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-2779
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Country | US
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Telephone | 208-884-1030
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Fax | 208-884-3058
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Provider Business Mailing Address
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Address Line | 1620 S CELEBRATION AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-2779
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Country | US
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Telephone | 208-884-1030
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Fax | 208-884-3058
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATIE APPLE
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Credential |
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Telephone | 208-884-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | ID
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