Basic Information
| Provider Information | |||||||||
| NPI: | 1033117460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TREASURE VALLEY HEARING AND BALANCE CLINIC, INC | ||||||||
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| OtherOrganizationName: | TREASURE VALLEY HEARING | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1084 N COLE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770019 | ||||||||
| FaxNumber: | 2083770313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 N COLE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083770019 | ||||||||
| FaxNumber: | 2083770313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2005 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | ELCOX | ||||||||
| AuthorizedOfficialFirstName: | JACQUIE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2083770019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BC-HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.