Healthcare Provider Details

I. General information

NPI: 1104093368
Provider Name (Legal Business Name): OUR LADY OF LOURDES HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 N ROAD 68
PASCO WA
99301-9189
US

IV. Provider business mailing address

520 N 4TH AVE
PASCO WA
99301-5257
US

V. Phone/Fax

Practice location:
  • Phone: 509-543-9300
  • Fax: 509-545-5049
Mailing address:
  • Phone: 509-543-9300
  • Fax: 509-545-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: JOHN SERLE
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 509-543-2483