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General NPI Number Information
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NPI Number | 1578826194
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 128 PEASLEY ST
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City | BOISE
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State | ID
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Zip | 83705-1641
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Country | US
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Telephone | 208-861-3509
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Fax |
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Provider Business Mailing Address
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Address Line | 128 PEASLEY ST
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City | BOISE
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State | ID
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Zip | 83705-1641
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CSA
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Name | HEIDI PROPST
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Credential |
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Telephone | 208-861-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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