Organization
TREASURE VALLEY EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GATEWOOD (PRESIDENT)
(805) 563-3011
Entity
Organization
Contact information
Practice address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5100
Mailing address
PO BOX 13309, PHILADELPHIA, PA 19101-3309
(805) 563-3011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010142021
BLUE SHIELD
ID
01
—
8H005
BLUE CROSS
ID
01
—
DD9057
RAILROAD MEDICARE
ID
Enumeration date
05/08/2006
Last updated
04/20/2008
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