Treasure Valley Vein and Wound Center LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

TREASURE VALLEY VEIN AND WOUND CENTER LLC

Practice address

10557 W Carlton Bay Dr Ste 106
Garden City, ID 83714-5200

Phone

(304) 617-1511

NPI assigned

Dec 13, 2023

Last updated

May 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ashley W Bennett, MDNPI 1326252545

Title

Owner Provider

Phone

(304) 617-1511

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ashley W Bennett, MD

  • Surgery Physician
  • Boise, ID
  • NPI 1326252545
  Medicare reassignment NPD Authorized official
• Michael A. Stewart, M.D.

  • Surgery Physician
  • Brookhaven, MS
  • NPI 1134333255
  NPD (past)

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

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1336917913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10557 W CARLTON BAY DR STE 106",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837145200",
            "telephone_number": "304-617-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10557 W CARLTON BAY DR STE 106",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837145200",
            "telephone_number": "304-617-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREASURE VALLEY VEIN AND WOUND CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-13",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER PROVIDER",
        "authorized_official_telephone_number": "304-617-1511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela L Tate, DO
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Boise Village)
• Toney Mental Health LLC
• Joseph Graham Toney
• Hailey Townsend, LPC
• Trueform Health Solutions (TrueForm Corrective Chiropractic)
• Yomirra Al Tussa
• Unicare Health Services of Idaho L.L.C.
• Vitality Health
• Sara Walton, N.M.D.

• Surgery Physician in Garden City, ID
• Providers in Garden City, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.