Healthcare Provider Details

I. General information

NPI: 1821386822
Provider Name (Legal Business Name): OUR LADY OF LOURDES HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH AVE
PASCO WA
99301-5257
US

IV. Provider business mailing address

520 N 4TH AVE 1ST FLOOR
PASCO WA
99301-5257
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-8849
  • Fax:
Mailing address:
  • Phone: 509-546-2231
  • Fax: 509-543-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN SERLE
Title or Position: PATIENT ACCOUNT SUPERVISOR
Credential:
Phone: 509-543-2483