| Treasure Valley Metabolic Medicine | |
|
951 E Plaza Dr Ste 110 Eagle ID 83616-6567 | |
| (208) 274-9580 | |
| (208) 274-9581 |
| Full Name | Treasure Valley Metabolic Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 951 E Plaza Dr Ste 110, Eagle, Idaho |
| Authorized Official Name and Position | Katy Connley (CEO, OWNER) |
| Authorized Official Contact | 2088306773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Treasure Valley Metabolic Medicine 951 E Plaza Dr Ste 110 Eagle ID 83616-6567 Ph: (208) 274-9580 | Treasure Valley Metabolic Medicine 951 E Plaza Dr Ste 110 Eagle ID 83616-6567 Ph: (208) 274-9580 |
| NPI Number | 1285271635 |
|---|---|
| Provider Enumeration Date | 12/04/2019 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/23/2021 |
| Medicare PECOS PAC ID | 6305276064 |
|---|---|
| Medicare Enrollment ID | O20200501002457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285271635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | () | Primary |
| Provider Name | Katy Connley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679980551 PECOS PAC ID: 8921224619 Enrollment ID: I20140929002787 |
| Provider Name | Joshua J Wageman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770925257 PECOS PAC ID: 8224441910 Enrollment ID: I20210120000838 |
| Provider Name | Megan Lee Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083357651 PECOS PAC ID: 7517343155 Enrollment ID: I20221004003723 |
| Provider Name | Laurel Kate Defoggi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356195200 PECOS PAC ID: 0648713891 Enrollment ID: I20240617002564 |
Eagle Creek Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1281 E. Iron Eagle Dr, Eagle, ID 83616 Phone: 208-939-5535 Fax: 208-939-5536 |
Primary Health Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1895 Mcgrath Rd, Eagle, ID 83616 Phone: 208-939-8200 Fax: 208-939-8222 |
Enhanced Aesthetics and Wellness Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 367 S Academy Ln, Eagle, ID 83616 Phone: 985-778-7582 |
Family & Functional Medicine of Idaho PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 450 W State St, Suite 250, Eagle, ID 83616 Phone: 208-947-0925 Fax: 208-947-0926 |
Linda D Burke MD PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 445 S. Fitness Place, Eagle, ID 83616 Phone: 208-939-2332 Fax: 208-939-7676 |
Summit Medical Providers LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2205 E Riverside Dr, Eagle, ID 83616 Phone: 801-867-9760 Fax: 801-880-4400 |