NPIMap

Organization Active NPI

Comanche County Hospital Authority

Doing business as LCHC Medicine Park

  • Federally Qualified Health Center (FQHC)
  • Medicine Park, OK
National Provider Identifier
1124694542
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMANCHE COUNTY HOSPITAL AUTHORITY
Doing business as
LCHC Medicine Park
Practice address
19055 State Highway 49
Medicine Park, OK 73507
Phone
(580) 585-5503
NPI assigned
May 27, 2021
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Brent Smith
Title
Ceo
Phone
(580) 585-5522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

19055 State Highway 49
Medicine Park, OK 73507

Mailing address

3401 W Gore Blvd
Lawton, OK 73505-6300
Phone (580) 585-5443

Other names 1

  • LCHC Medicine Park Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211229001209 OK Part A Provider - Federally Qualified Health Center (FQHC) 2668373689 Practice locations: Medicine Park, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124694542. Details of each certification follow.

Federally qualified health center certification: CCN 371975

Legal name
COMANCHE COUNTY HOSPITAL AUTHORITY
Doing business as
LCHC MEDICINE PARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 22, 2021
Last certification
Dec 22, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
19055 State Highway 49
Medicine Park, OK 73507-6022

National Provider Directory

National Provider Directory
Tax ID family
Comanche Co Mem Dba Sou40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

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

View all 39

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
George W Kruger Individual W-2 Managing EmployeeCfo Aug 3, 2015
Comanche County Hospital Authority Organization, Lawton, OK Non-profit Operational/Managerial Control Jun 1, 2020
Ladonna Meyer Individual Corporate OfficerMember May 1, 2020
Kathleen Cooper Individual Corporate Officer Aug 9, 2019
Richard Rogalski Individual Corporate Officer Sep 1, 2015
Brent L Smith Individual Corporate DirectorCeo Apr 1, 2014
W-2 Managing EmployeeCeo Apr 1, 2014
Rosemary Bellino Hall Individual Corporate OfficerMember May 1, 2020
Brenda Spencer Ragland Individual Corporate Officer Jul 1, 2011
Sean McAvoy Individual Corporate Director Feb 4, 2013
W-2 Managing Employee Feb 4, 2013
Virginia Breeden Individual Corporate OfficerOfficer Jul 1, 2016
Buster Swoopes Individual Corporate OfficerMember Jul 1, 2016

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Memorial HealthLawton, OK, CCN 37T056 Hospital Operational/Managerial Control Jan 13, 1971
Memorial HealthLawton, OK, CCN 370056 Hospital Operational/Managerial Control Jan 13, 1971
McMahon Tomlinson Nursing & Rehabilitation CenterLawton, OK, CCN 375562 Skilled nursing facility Operational/Managerial Control Jan 13, 1971
Comanche County Memorial Hospital Home Health CareLawton, OK, CCN 377070 Home health agency Operational/Managerial Control Jan 13, 1971
Comanche County Memorial Hospice and Supportive CareLawton, OK, CCN 371713 Hospice Operational/Managerial Control Jan 13, 1971
Lawton Community Health CenterLawton, OK, CCN 371846 Federally qualified health center Operational/Managerial Control Mar 6, 2008
Comanche County Hospital AuthorityLawton, OK, CCN 371962 Federally qualified health center Operational/Managerial Control Jan 13, 1971
LCHC Family Continuity ClinicLawton, OK, CCN 371017 Federally qualified health center Operational/Managerial Control (100%) Aug 29, 2023
MMG Snyder Family Medical ClinicSnyder, OK, CCN 373443 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1996

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1124694542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056300",
            "telephone_number": "580-585-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19055 STATE HIGHWAY 49",
            "city": "MEDICINE PARK",
            "state": "OK",
            "postal_code": "73507",
            "telephone_number": "580-585-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-585-5522"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCHC Medicine Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LCHC Medicine Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medicine Park, OK

Sources for this page

Verify at the official NPI Registry.