1356592489 NPI number — OUR LADY OF LOURDES HEATH CENTER

Table of content: (NPI 1356592489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356592489 NPI number — OUR LADY OF LOURDES HEATH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR LADY OF LOURDES HEATH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOURDES COLUMBIA POINT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356592489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 COLUMBIA POINT DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-4390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-943-7997
Provider Business Mailing Address Fax Number:
509-943-7955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 COLUMBIA POINT DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-943-7997
Provider Business Practice Location Address Fax Number:
509-943-7955
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SERLE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
509-543-2483

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  113003371 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7144314 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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