NPIMap

Organization Active NPI

Lincoln County Hospital District #3

Doing business as North Basin Medical Clinics

  • Rural Health Clinic/Center
  • Wilbur, WA
National Provider Identifier
1972547610
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LINCOLN COUNTY HOSPITAL DISTRICT #3
Doing business as
North Basin Medical Clinics
North Basin Medical Clinics--Wilbur Clinic
Practice address
214 SW Main St
Wilbur, WA 99185
Phone
(509) 647-5321
Fax
(509) 647-2238
NPI assigned
Jun 15, 2006
Last updated
Jun 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
LINCOLN COUNTY HOSPITAL DISTRICT #3As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Authorized official

Name
Tyson E Lacy
Title
Ceo
Phone
(509) 725-2979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H-137 WA
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

214 SW Main St
Wilbur, WA 99185

Mailing address

10 Nicholls St
Davenport, WA 99122-9729
Phone (509) 725-7501

Other identifiers 3

IdentifierTypeStateIssuer
CJ6525OtherWAMEDICARE RAILROAD
7101132MedicaidWA
7117450MedicaidWA

Other names 3

  • North Basin Medical Clinics Doing business as
  • North Basin Medical Clinics--Wilbur Clinic Doing business as
  • Wilbur Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505000483 WA Part B Supplier - Clinic/Group Practice 3971591199 Receives reassigned benefits from 21 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, WA
O20081021000398 WA Part A Provider - Rural Health Clinic 3971591199 Practice locations: Wilbur, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972547610. Details of each certification follow.

Rural health clinic certification: CCN 508530

Legal name
LINCOLN COUNTY HOSPITAL DISTRICT 3
Doing business as
NORTH BASIN MEDICAL CLINICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2003
Last certification
Oct 12, 2016
Ownership / control type
Non-profit – church related
Organization structure
GovernmentProprietary
Incorporated
Jan 1, 1962 in WA
Enrollment address
214 SW Main St
Wilbur, WA 99185-5155
Related CCNs
501305

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0661590North Basin Medical Clinics - Wilbur Clinic214 SW Main St, Wilbur, WA 99185Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lincoln Hospital Distri5 organizations share this tax ID, including this one
Part of
Lincoln Hospital Distri

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer Larmer Individual Corporate OfficerChief Patient Services Officer Feb 1, 2001
Lincoln County Hospital District 3 Organization, Davenport, WA Medical provider/supplier Other Jun 15, 2006 100%
Tyson Lacy Individual Corporate OfficerCeo Oct 22, 2008
W-2 Managing EmployeeAd; Oct 22, 2008

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Lincoln County Hospital District 3Davenport, WA, CCN 501305 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Lincoln County Hospital District 3Davenport, WA, CCN 50Z305 Hospital Operational/Managerial Control (100%) Jan 1, 1966
North Basin Medical ClinicsDavenport, WA, CCN 508529 Rural health clinic Operational/Managerial Control Oct 23, 2007
North Basin Medical ClinicsReardan, WA, CCN 508528 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2002

Owned or controlled facilities with NPI records 5

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782432000000",
    "number": "1972547610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 NICHOLLS ST",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991229729",
            "telephone_number": "509-725-7501",
            "fax_number": "509-725-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 SW MAIN ST",
            "city": "WILBUR",
            "state": "WA",
            "postal_code": "99185",
            "telephone_number": "509-647-5321",
            "fax_number": "509-647-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY HOSPITAL DISTRICT #3",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINCOLN COUNTY HOSPITAL DISTRICT #3",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-725-2979"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "H-137",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CJ6525",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101132",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7117450",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Basin Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Basin Medical Clinics--Wilbur Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wilbur Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wilbur Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wilbur, WA

Sources for this page

Verify at the official NPI Registry.