Organization
LINCOLN COUNTY HOSPITAL DISTRICT #3 / NORTH BASIN MEDICAL CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON LACY (CEO)
(509) 725-2979
Entity
Organization
Contact information
Practice address
10 NICHOLLS ST, DAVENPORT, WA 99122-9729
(509) 725-7501
(509) 725-7504
Mailing address
10 NICHOLLS ST, DAVENPORT, WA 99122-9729
(509) 725-7101
(509) 725-2112
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7117435
NORTH BASIN MEDICAL REARDAN CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA
01
—
7117443
NORTH BASIN MEDICAL WILBUR CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA
01
—
7117450
NORTH BASIN MEDICAL DAVENPORT CLINIC MEDICAID RURAL HEALTH CORE PROVIDER #
WA
Enumeration date
10/13/2016
Last updated
02/26/2026
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