Provider Demographics
NPI:1063419018
Name:WALTER KNOX MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WALTER KNOX MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMPFLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-901-3213
Mailing Address - Street 1:1202 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2715
Mailing Address - Country:US
Mailing Address - Phone:208-365-3561
Mailing Address - Fax:208-365-4176
Practice Address - Street 1:1202 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2715
Practice Address - Country:US
Practice Address - Phone:208-365-3561
Practice Address - Fax:208-365-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID07282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005890OtherREGENCE BS HOSPITAL
ID002811000Medicaid
ID002811100OtherMEDICAID DR. PROVIDER #
ID002811500OtherMEDICAID ANESTHESIA PROV#
CAXHSP40645OtherMEDICAID CA OUT PATIENT
ID000010005891OtherREGENCE BS PROFESSIONAL
ID002811200OtherMEDICAID PHARMACY PROV #
KY0101300227002OtherMEDICAID KENTUCKY
ID8K446OtherBLUE CROSS PROFESSIONAL
CAXHSP30645OtherMEDICAID CA IN PATIENT
ID00091OtherBC HOSPITAL PROV #
AZ109654OtherMEDICAID ARIZONA
MT4103426OtherMEDICAID MONTANA
ID1252002OtherMEDICARE PROF. FEE PROV #
ID805213700OtherMEDICAID ER ROOM PHYSICIA
CO95002960OtherMEDICAID COLORADO
ID002811000Medicaid