Provider Demographics
NPI:1124193271
Name:WESTERN MEDICAL SERVICES OF TREASURE VALLEY, INC.
Entity Type:Organization
Organization Name:WESTERN MEDICAL SERVICES OF TREASURE VALLEY, INC.
Other - Org Name:FAMILY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-0112
Mailing Address - Street 1:2950 E. MAGIC VIEW DR.
Mailing Address - Street 2:# 192
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-401-0112
Mailing Address - Fax:208-401-0118
Practice Address - Street 1:2950 E. MAGIC VIEW DR.
Practice Address - Street 2:# 192
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-401-0112
Practice Address - Fax:208-401-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID02675OtherBLUE CROSS PROVIDER NUMBE
ID137079Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER