Basic Information
| Provider Information | |||||||||
| NPI: | 1033473517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR LADY OF LOURDES HOSPITAL AT PASCO | ||||||||
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| OtherOrganizationName: | LOURDES HEALTH AND WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4215 CONVENTION PL | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094168849 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4215 CONVENTION PL | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094168849 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | SERLE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5095432483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 2081P0004X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | 2081P2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081S0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.