Provider Demographics
NPI:1578179743
Name:TREASURE VALLEY NASAL AND SINUS CENTER, PLLC
Entity type:Organization
Organization Name:TREASURE VALLEY NASAL AND SINUS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-870-6647
Mailing Address - Street 1:1157 N SUMMERBROOK AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8759
Mailing Address - Country:US
Mailing Address - Phone:208-593-4484
Mailing Address - Fax:
Practice Address - Street 1:1157 N SUMMERBROOK AVE STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8759
Practice Address - Country:US
Practice Address - Phone:208-593-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty