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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
1261QR1300XRural Health Clinic/Center13-8525ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
7138525OTHERIDMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113-8525OTHERIDRURAL HEALTH CLINIC PTAN
28E001OTHERIDBLUE CROSS OF IDAHO GROUP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4138525OTHERUNSPECIFIED
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10000010006204OTHERIDREGENCE BLUE SH OF ID GRP
11MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821091083
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALTER KNOX MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 1102 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2713
Country : US
Telephone Number : 208-365-6004
Fax Number : 208-365-3589
Provider Business Practice Location Address
First Line : 1102 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2713
Country : US
Telephone Number : 208-365-6004
Fax Number : 208-365-3589
Authorized Official
Title or Position : CEO
Name : BRAD TURPEN
Credential :
Telephone Number : 208-999-3870
Provider Enumeration Date : 05/23/2005
Last Update Date : 11/30/2019

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83617-2713
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1427558154 — MS. DESIREE DARLENE REID PA-C
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