1366682973 NPI number — OUR LADY OF LOURDES HEALTH CENTER

Table of content: (NPI 1366682973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366682973 NPI number — OUR LADY OF LOURDES HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR LADY OF LOURDES HEALTH 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 HOSPITALIST PROGRAM
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:
1366682973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 N 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99301-5257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-547-7704
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 N 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-5257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-7704
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2009

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: 208M00000X , 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: G8855265 . This is a "PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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