Provider Demographics
NPI:1841603768
Name:TREASURE VALLEY FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:TREASURE VALLEY FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CROWNOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-895-0050
Mailing Address - Street 1:2428 N STOKESBERRY PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5035
Mailing Address - Country:US
Mailing Address - Phone:208-895-0050
Mailing Address - Fax:208-887-0033
Practice Address - Street 1:2428 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5035
Practice Address - Country:US
Practice Address - Phone:208-895-0050
Practice Address - Fax:855-543-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QP2300X
IDM11819261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care