Healthcare Provider Details

I. General information

NPI: 1023122520
Provider Name (Legal Business Name): LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E AMENDE
ODESSA WA
99159
US

IV. Provider business mailing address

PO BOX 190
ODESSA WA
99159-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-982-2611
  • Fax: 509-982-2159
Mailing address:
  • Phone: 509-982-2611
  • Fax: 509-982-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN SERLE
Title or Position: CEO
Credential:
Phone: 509-982-2611