Provider Demographics
NPI:1134220387
Name:OUR LADY OF LOURDES HEALTH CENTER
Entity type:Organization
Organization Name:OUR LADY OF LOURDES HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT 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:509-546-2231
Mailing Address - Street 1:531 W PARK ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5270
Mailing Address - Country:US
Mailing Address - Phone:509-547-6617
Mailing Address - Fax:509-547-6435
Practice Address - Street 1:531 W PARK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5270
Practice Address - Country:US
Practice Address - Phone:509-547-6617
Practice Address - Fax:509-547-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8855367Medicare PIN