Provider Demographics
NPI:1417967696
Name:TREASURE VALLEY ENDOCRINOLOGY PC
Entity Type:Organization
Organization Name:TREASURE VALLEY ENDOCRINOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-367-6740
Mailing Address - Street 1:PO BOX 4143
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-4143
Mailing Address - Country:US
Mailing Address - Phone:208-367-6740
Mailing Address - Fax:208-367-6742
Practice Address - Street 1:900 N LIBERTY ST STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8707
Practice Address - Country:US
Practice Address - Phone:208-367-6740
Practice Address - Fax:208-367-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILM 6551207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807326100Medicaid
ID1368639Medicare PIN