Organization
WALTER KNOX MEMORIAL HOSPITAL
Active
Other names
Valor Health - Emmett Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD TURPEN (CEO)
(208) 999-3870
Entity
Organization
Contact information
Practice address
1102 E LOCUST ST, EMMETT, ID 83617-2713
(208) 365-6004
(208) 365-3589
Mailing address
1102 E LOCUST ST, EMMETT, ID 83617-2713
(208) 365-6004
(208) 365-3589
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
13-8525
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006204
REGENCE BLUE SH OF ID GRP
ID
05
—
000269700
—
ID
05
—
002563400
—
ID
05
—
002563800
—
ID
01
—
13-8525
RURAL HEALTH CLINIC PTAN
ID
01
—
138525
MEDICARE PTAN
ID
01
—
138525
UNSPECIFIED
—
05
—
805187500
—
ID
05
—
806367900
—
ID
05
—
807437800
—
ID
01
—
8E001
BLUE CROSS OF IDAHO GROUP
ID
Enumeration date
05/23/2005
Last updated
11/30/2019
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