| 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 |
| Medicare PECOS PAC ID | 6305276064 |
|---|---|
| Medicare Enrollment ID | O20200501002457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285271635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Katy Connley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679980551 PECOS PAC ID: 8921224619 Enrollment ID: I20140929002787 |
| Provider Name | Kirsten Ceily Thomas |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1265066849 PECOS PAC ID: 3971934886 Enrollment ID: I20200508002726 |
| Provider Name | Jennifer Mahlberg-grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982126686 PECOS PAC ID: 6709150717 Enrollment ID: I20210108000490 |
| Provider Name | Megan Lee Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083357651 PECOS PAC ID: 7517343155 Enrollment ID: I20221004003723 |
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