Provider Demographics
NPI:1346318920
Name:OUR LADY OF LOURDES HEALTH CENTER
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES HEALTH CENTER
Other - Org Name:LOURDES WOMENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-543-2483
Mailing Address - Street 1:516 W MARGARET ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5273
Mailing Address - Country:US
Mailing Address - Phone:509-542-8232
Mailing Address - Fax:509-547-6747
Practice Address - Street 1:516 W MARGARET ST
Practice Address - Street 2:SUITE 9
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5273
Practice Address - Country:US
Practice Address - Phone:509-542-8232
Practice Address - Fax:509-547-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB08875Medicare PIN