MEDICARE: WALTER KNOX MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RR0500X	Rheumatology Physician
2	208600000X	Surgery Physician
3	213ES0103X	Foot & Ankle Surgery Podiatrist
4	174400000X	Specialist

General Provider Information

NPI Number	:	1326206947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER KNOX MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1202 E LOCUST ST
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-2715
Country	:	US
Telephone Number	:	208-365-3561
Fax Number	:	208-365-4176

Provider Business Practice Location Address
First Line	:	1024 E LOCUST ST
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-2776
Country	:	US
Telephone Number	:	208-365-3561
Fax Number	:	208-365-4176

Authorized Official
Title or Position	:	CFO
Name	:	PAM STAMPFLI
Credential	:
Telephone Number	:	208-901-3213

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	11/30/2019

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