Provider Demographics
NPI:1396824512
Name:TREASURE VALLEY PEDIATRICS
Entity Type:Organization
Organization Name:TREASURE VALLEY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-884-1030
Mailing Address - Street 1:1620 S CELEBRATION AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2779
Mailing Address - Country:US
Mailing Address - Phone:208-884-1030
Mailing Address - Fax:208-884-3058
Practice Address - Street 1:1620 S CELEBRATION AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2779
Practice Address - Country:US
Practice Address - Phone:208-884-1030
Practice Address - Fax:208-884-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty