Provider Demographics
NPI:1295193423
Name:WALTER KNOX MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WALTER KNOX MEMORIAL HOSPITAL
Other - Org Name:VALOR HEALTH FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAXECHEBARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-901-3204
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:
Mailing Address - Fax:
Practice Address - Street 1:119 N WARDWELL AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3040
Practice Address - Country:US
Practice Address - Phone:208-365-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care