Provider Demographics
NPI:1366142127
Name:TREASURE VALLEY CHILDRENS CLINIC, PC
Entity type:Organization
Organization Name:TREASURE VALLEY CHILDRENS CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-420-9330
Mailing Address - Street 1:1775 W STATE ST # 229
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3924
Mailing Address - Country:US
Mailing Address - Phone:208-297-7847
Mailing Address - Fax:208-203-0097
Practice Address - Street 1:2921 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7961
Practice Address - Country:US
Practice Address - Phone:208-297-7847
Practice Address - Fax:208-203-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty