NPIMap

Organization Active NPI

LTAC Hospital of Edmond, LLC

  • Long Term Care Hospital
  • Oklahoma City, OK
National Provider Identifier
1093016818
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
LTAC HOSPITAL OF EDMOND, LLC
Practice address
4300 W Memorial Rd FL 2
Oklahoma City, OK 73120-8304
Phone
(405) 936-5822
Fax
(405) 936-5559
NPI assigned
Nov 10, 2010
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Mr. Timothy W. Howard
Title
President
Phone
(337) 269-9566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

4300 W Memorial Rd FL 2
Oklahoma City, OK 73120-8304

Mailing address

101 La Rue France
Suite 500
Lafayette, LA 70508-3144
Phone (337) 269-9566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110310000665 MD Part A Provider - Hospital 3971785064 Practice locations: Oklahoma City, OK
O20131223000546 OK Part B Supplier - Clinic/Group Practice 3971785064 Receives reassigned benefits from 1 practitioner
Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093016818. Details of each certification follow.

Hospital certification: CCN 372005

Legal name
LTAC HOSPITAL OF EDMOND, LLC
Doing business as
OKC-AMG SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jun 1, 1993
Last certification
Nov 2, 2022
Beds
18
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 10, 2011 (3 total)
Organization structure
LLCProprietary
Incorporated
Dec 1, 2010 in OK
Enrollment address
4300 W Memorial Road 2ND Floor
Edmond-Amg Specialty Hospital
Oklahoma City, OK 73120-8304
Other Hospital Practice Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Okc-Amg Specialty HospitalCCN 372005 · All quality measures
Ownership
For profit
Certified
Jun 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Beds
18

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
37D2082526LTAC Hospital of Edmond, LLC4300 W Memorial Rd, 2ND Floor, Oklahoma City, OK 73120Certificate of waiverAug 17, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Amg 2 0 Holdco Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Dec 27, 2019 100%
Amg 2 0 LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest May 9, 2018 100%
Timothy W Howard Individual Corporate OfficerCeo Dec 27, 2019 100%
Corporate DirectorBoard Member Oct 11, 2010 50%
Jessica L McGee Individual Corporate OfficerCfo Oct 11, 2010 25%
Erick Heflin Individual W-2 Managing EmployeeHospital Administrator/Ceo Sep 24, 2018 50%
August J Rantz Individual Corporate OfficerPresident Dec 27, 2019 100%
Corporate Director Dec 27, 2019 100%
Amg Employee Stock Ownership Plan Organization, Lafayette, LA 5% Or Greater Indirect Ownership Interest Dec 27, 2019 100%

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1093016818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE",
            "address_2": "SUITE 500",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083144",
            "telephone_number": "337-269-9566",
            "fax_number": "337-234-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD FL 2",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208304",
            "telephone_number": "405-936-5822",
            "fax_number": "405-936-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTAC HOSPITAL OF EDMOND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-269-9566",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.