Provider Demographics
NPI:1215992003
Name:TREASURE VALLEY ANESTHESIA PC
Entity type:Organization
Organization Name:TREASURE VALLEY ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAWVER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:208-604-0348
Mailing Address - Street 1:24442 NUBIAN GOAT CT
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8525
Mailing Address - Country:US
Mailing Address - Phone:208-604-0348
Mailing Address - Fax:
Practice Address - Street 1:351 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-881-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006401000OtherREGENCE BCBSO
OR276579Medicaid
ID805134400Medicaid
ID805134400Medicaid