Healthcare Provider Details

I. General information

NPI: 1093882383
Provider Name (Legal Business Name): OUR LADY OF LOURDES HOSPITAL AT PASCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 SANDIFUR PKWY
PASCO WA
99301-8941
US

IV. Provider business mailing address

9915 SANDIFUR PKWY
PASCO WA
99301-8941
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-2222
  • Fax: 509-546-2202
Mailing address:
  • Phone: 509-546-2222
  • Fax: 509-546-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

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