Provider Demographics
NPI:1639503774
Name:OUR LADY OF LOURDES HOSPITAL AT PASCO
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES HOSPITAL AT PASCO
Other - Org Name:LOURDES URGENT CARE RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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:509-416-8849
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-2568
Mailing Address - Country:US
Mailing Address - Phone:509-416-8849
Mailing Address - Fax:509-542-3059
Practice Address - Street 1:5304 N ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9189
Practice Address - Country:US
Practice Address - Phone:509-543-9300
Practice Address - Fax:509-545-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHACDS000000222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty