NPIMap

Organization Active NPI

Lincoln County Public Hospital District 1

  • Family Medicine Physician
  • Odessa, WA
National Provider Identifier
1740317544
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1
Practice address
510 E. Amende
Odessa, WA 99159
Phone
(509) 982-2611
Fax
(509) 982-2675
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Serle
Title
Ceo
Phone
(509) 982-2611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

510 E. Amende
Odessa, WA 99159

Mailing address

PO Box 190
Odessa, WA 99159
Phone (509) 982-2611

Other identifiers 1

IdentifierTypeStateIssuer
7013337MedicaidWA

Other names 1

  • Odessa Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309001439 WA Part B Supplier - Clinic/Group Practice 1052209152 Receives reassigned benefits from 11 practitioners
Practice locations: Odessa, WA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Odessa Memorial Healthcare CenterOdessa, WA, CCN 501307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Odessa Memorial Healthcare CenterOdessa, WA, CCN 50Z307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Odessa ClinicOdessa, WA, CCN 508501 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1740317544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "ODESSA",
            "state": "WA",
            "postal_code": "99159",
            "telephone_number": "509-982-2611",
            "fax_number": "509-982-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E. AMENDE",
            "city": "ODESSA",
            "state": "WA",
            "postal_code": "99159",
            "telephone_number": "509-982-2611",
            "fax_number": "509-982-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "SERLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-982-2611"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7013337",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odessa Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Odessa Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odessa, WA

Sources for this page

Verify at the official NPI Registry.