NPIMap

Organization Active NPI

Lawrence Memorial Health Foundation Inc.

Doing business as Lawrence Memorial Hospital

  • Critical Access Hospital
  • Walnut Ridge, AR
National Provider Identifier
1194724658
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
AR3842 Issued in AR
Legal business name
LAWRENCE MEMORIAL HEALTH FOUNDATION INC.
Doing business as
Lawrence Memorial Hospital
Practice address
1309 W Main St
Walnut Ridge, AR 72476-1430
Phone
(870) 886-1200
Fax
(870) 886-5340
NPI assigned
Jul 18, 2005
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Mrs. Vanessa K Wagner
Title
Cfo
Phone
(870) 886-1263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X AR3842 AR Primary

Addresses

Primary practice location

1309 W Main St
Walnut Ridge, AR 72476-1430

Mailing address

PO Box 839
Walnut Ridge, AR 72476-0839
Phone (870) 886-1200

Other identifiers 1

IdentifierTypeStateIssuer
233684105MedicaidAR

Other names 1

  • Lawrence Memorial Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Lawrence.Memorial@lmh.hin.us Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190128000431 AR Part A Provider - Critical Access Hospital 9436305836 Receives reassigned benefits from 13 practitioners
Practice locations: Walnut Ridge, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194724658. Details of each certification follow.

Hospital certification: CCN 041309

Legal name
LAWRENCE MEMORIAL HEALTH FOUNDATION INC
Doing business as
LAWRENCE MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 31, 2000
Last certification
May 5, 2023
Beds
25
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jan 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 1998 in AR
Enrollment address
1309 West Main
Walnut Ridge, AR 72476-1430
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Lawrence Memorial HospitalCCN 041309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Lawrence Mem HLTH FNDT Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1309 W Main St
#348
Walnut Ridge, AR 72476

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
William F Wilcoxson Individual Corporate DirectorBoard Member Jun 1, 2015
John H Thomison Individual Corporate DirectorBoard of Directors Jan 1, 2023
Ashley Burris Individual Corporate DirectorBoard of Governords Oct 21, 2024
Sebastian a Spades Individual Corporate DirectorBoard Member Jul 1, 1994
Jeff Yates Individual Corporate DirectorBoard of Governors Jun 17, 2024
Bonita a Staudt Individual Corporate DirectorBoard Member Jan 1, 2010
Gregory P McElhanon Individual Corporate DirectorCfo Apr 1, 2023
W-2 Managing EmployeeCfo Apr 1, 2023
James Blake Perkins Individual Corporate DirectorBoard Member Jan 1, 2017
Jeremy Hopper Individual Corporate DirectorBoard of Director Dec 1, 2023
Rhonda Forrester Individual Corporate DirectorBoard Member Dec 1, 2018
Aaron Andrews Individual Corporate DirectorBoard of Director Sep 1, 2021
Wilma M Jones Individual Corporate DirectorBoard Member May 1, 2017
Lila J Floyd Individual Corporate DirectorBoard Member Jul 1, 2004
Kerry Dalton Individual Corporate DirectorBoard Member Dec 1, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 95

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

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1194724658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 839",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724760839",
            "telephone_number": "870-886-1200",
            "fax_number": "870-886-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761430",
            "telephone_number": "870-886-1200",
            "fax_number": "870-886-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE MEMORIAL HEALTH FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-886-1263",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR3842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "233684105",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lawrence.Memorial@lmh.hin.us",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1309 W Main St",
            "city": "Walnut Ridge",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724761430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lawrence Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Ridge, AR

Sources for this page

Verify at the official NPI Registry.