Healthcare Provider Details

I. General information

NPI: 1265422935
Provider Name (Legal Business Name): DOUGLAS, GRANT, LINCOLN & OKANOGAN COUNTIES PUBLIC HOSPITAL DISTRICT 6
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

IV. Provider business mailing address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-1753
  • Fax: 509-633-3644
Mailing address:
  • Phone: 509-633-1753
  • Fax: 509-633-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberHAC.FS.00000150
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberHAC.FS.00000150
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberHAC.FS.00000150
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberHAC.FS.00000150
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberHAC.FS.00000150
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHAC.FS.00000150
License Number StateWA

VIII. Authorized Official

Name: KELLY HUGHES
Title or Position: CEO
Credential:
Phone: 509-633-1753