Treasure Valley Colon & Rectal Clinic PLLC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

M11186 Issued in ID

Legal business name

TREASURE VALLEY COLON & RECTAL CLINIC PLLC

Practice address

1072 N Liberty St
Suite 201
Boise, ID 83704-8706

Phone

(208) 377-2273

Fax

(208) 367-3059

NPI assigned

Feb 8, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Johnny B Green, M.D.

Title

President

Phone

(208) 377-2273

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1316243371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST",
            "address_2": "SUITE 201",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048706",
            "telephone_number": "208-377-2273",
            "fax_number": "208-367-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST",
            "address_2": "SUITE 201",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048706",
            "telephone_number": "208-377-2273",
            "fax_number": "208-367-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREASURE VALLEY COLON & RECTAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-377-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "ID",
            "license": "M11186",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "ID",
            "license": "M11186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Colon & Rectal Surgery Physician in Boise, ID
• Providers in Boise, ID by specialty
• Colon & Rectal Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.