Provider Demographics
NPI:1487735254
Name:TREASURE VALLEY PODIATRY, INC
Entity type:Organization
Organization Name:TREASURE VALLEY PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-367-7887
Mailing Address - Street 1:900 N LIBERTY ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8704
Mailing Address - Country:US
Mailing Address - Phone:208-367-7887
Mailing Address - Fax:208-367-7888
Practice Address - Street 1:900 N LIBERTY ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8704
Practice Address - Country:US
Practice Address - Phone:208-367-7887
Practice Address - Fax:208-367-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty