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1063419018

NPI Code Detail

MEDICARE: WALTER KNOX MEMORIAL HOSPITAL

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	License Number	License Number State
1	282NC0060X	Critical Access Hospital	07	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
14	1252002	OTHER	ID	MEDICARE PROF. FEE PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010005890	OTHER	ID	REGENCE BS HOSPITAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000010005891	OTHER	ID	REGENCE BS PROFESSIONAL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	8K446	OTHER	ID	BLUE CROSS PROFESSIONAL
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	00091	OTHER	ID	BC HOSPITAL PROV #
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063419018
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	:	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

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	11/07/2019

Similar Medicare Providers

1649264052 — DR. TREVOR D. TREDENNICK M.D.
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3561
Practice Fax:

1700909983 — WALTER KNOX MEMORIAL HOSPITAL
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3561
Practice Fax: 208-365-4176

1366741019 — DEBRA ANNE PHILLIPS FNP-BC
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3561
Practice Fax: 208-365-4176

1457641342 — CORY ONDLER D.O.
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3561
Practice Fax:

1760726897 — DR. JEROD L HINES M.D.
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3563
Practice Fax:

1841655826 — LISA ISAKSEN NP-C, PMHNP-BC
Practice Location Address:

1202 E LOCUST ST
EMMETT, ID
83617-2715

Practice Phone: 208-365-3561
Practice Fax: 208-365-3589

Directions to “WALTER KNOX MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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