Provider Demographics
NPI:1124394796
Name:TREASURE VALLEY HEARING AND BALANCE CLINIC, INC
Entity Type:Organization
Organization Name:TREASURE VALLEY HEARING AND BALANCE CLINIC, INC
Other - Org Name:TREASURE VALLEY HEARING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ELCOX
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:208-377-0019
Mailing Address - Street 1:1084 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8642
Mailing Address - Country:US
Mailing Address - Phone:208-377-0019
Mailing Address - Fax:208-377-0313
Practice Address - Street 1:1463 CALDWELL BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1607
Practice Address - Country:US
Practice Address - Phone:208-377-0019
Practice Address - Fax:208-377-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13756601Medicare PIN