Provider Demographics
NPI:1184844185
Name:DOUGLAS, GRANT, LINCOLN & OKANOGAN COUNTIES PUBLIC HOSPITAL DISTRICT 6
Entity Type:Organization
Organization Name:DOUGLAS, GRANT, LINCOLN & OKANOGAN COUNTIES PUBLIC HOSPITAL DISTRICT 6
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTILAING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-633-6345
Mailing Address - Street 1:411 FORTUYN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-8718
Mailing Address - Country:US
Mailing Address - Phone:509-633-1753
Mailing Address - Fax:509-633-1933
Practice Address - Street 1:411 FORTUYN RD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133
Practice Address - Country:US
Practice Address - Phone:509-633-1753
Practice Address - Fax:509-633-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020372Medicaid
WA501308Medicare Oscar/Certification