Organization
OUR LADY OF LOURDES HEALTH CENTER
Active
Other names
LOURDES RIVERVIEW MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SERLE (PRESIDENT & CEO)
(509) 543-2483
Entity
Organization
Contact information
Practice address
4403 W COURT ST, SUITE B, PASCO, WA 99301-2879
(509) 545-5358
Mailing address
4403 W COURT ST, SUITE B, PASCO, WA 99301-2879
(509) 545-6620
(509) 545-6842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
113003371
WA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
113003371
WA
207VX0000X
Obstetrics Physician
113003371
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7093933
—
WA
Enumeration date
10/24/2006
Last updated
04/17/2009
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