NPIMap

Organization Active NPI

Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Family Medicine Physician
  • Grand Coulee, WA
National Provider Identifier
1265422935
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HAC.FS.00000150 Issued in WA
Legal business name
DOUGLAS, GRANT, LINCOLN & OKANOGAN COUNTIES PUBLIC HOSPITAL DISTRICT 6
Practice address
411 Fortuyn Rd
Grand Coulee, WA 99133-8718
Phone
(509) 633-1753
Fax
(509) 633-3644
NPI assigned
Oct 25, 2005
Last updated
Apr 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Authorized official

Name
Kelly Hughes
Title
Ceo
Phone
(509) 633-1753

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X HAC.FS.00000150 WA
Emergency Medicine Physician 207P00000X HAC.FS.00000150 WA
Family Medicine Physician 207Q00000X HAC.FS.00000150 WA Primary
Diagnostic Radiology Physician 2085R0202X HAC.FS.00000150 WA
Surgery Physician 208600000X HAC.FS.00000150 WA
Nurse Practitioner 363L00000X HAC.FS.00000150 WA

Addresses

Primary practice location

411 Fortuyn Rd
Grand Coulee, WA 99133-8718

Mailing address

411 Fortuyn Rd
Grand Coulee, WA 99133-8718
Phone (509) 633-1753

Other identifiers 1

IdentifierTypeStateIssuer
1023564MedicaidWA

Other names 1

  • Coulee Medical Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000181 WA Part B Supplier - Clinic/Group Practice 9335050285 Receives reassigned benefits from 64 practitioners
Practice locations: Republic, WA; Grand Coulee, WA; Coulee City, WA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory

Locations

404 Fortuyn Rd
Grand Coulee, WA 99133
Phone (509) 633-1911

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Coulee Medical CenterGrand Coulee, WA, CCN 501308 Hospital Other Jan 1, 1990
Coulee Medical CenterGrand Coulee, WA, CCN 50Z308 Hospital Other Jan 1, 1990
Coulee Medical CenterCoulee City, WA, CCN 508535 Rural health clinic Other Feb 1, 1997
Coulee Family MedicineGrand Coulee, WA, CCN 503981 Rural health clinic Operational/Managerial Control Apr 29, 1992

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 66

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 66

NPI Registry JSON

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744588800000",
    "number": "1265422935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 FORTUYN RD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991338718",
            "telephone_number": "509-633-1753",
            "fax_number": "509-633-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 FORTUYN RD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991338718",
            "telephone_number": "509-633-1753",
            "fax_number": "509-633-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS, GRANT, LINCOLN & OKANOGAN COUNTIES PUBLIC HOSPITAL DISTRICT 6",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-633-1753"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "HAC.FS.00000150",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023564",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coulee Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Coulee, WA

Sources for this page

Verify at the official NPI Registry.