# TREASURE VALLEY FOOT AND ANKLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083261697
- **Authorized official:** CLARK A JOHNSON (PRESIDENT)
- **Authorized official phone:** (208) 546-9548

## Contact information

- **Practice address:** 3120 W BELLTOWER DR STE 100, MERIDIAN, ID 83646-7744
- **Practice address phone:** (208) 516-3617
- **Practice address fax:** (208) 314-2029
- **Mailing address:** PO BOX 268, BOUNTIFUL, UT 84011-0268
- **Mailing address phone:** (208) 516-3617
- **Mailing address fax:** (208) 314-2029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2019
- **Last updated:** 12/16/2019