NPIMap

Organization Active NPI

Comanche County Hospital Authority

Doing business as LCHC Cache

  • Federally Qualified Health Center (FQHC)
  • Cache, OK
National Provider Identifier
1285294298
Registry record updated Sep 2, 2020
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 Cache
Practice address
512 W C Ave
Cache, OK 73527-9491
Phone
(580) 699-7355
Fax
(580) 699-7362
NPI assigned
Jun 20, 2019
Last updated
Sep 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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 Primary

Addresses

Primary practice location

512 W C Ave
Cache, OK 73527-9491

Mailing address

3401 W Gore Blvd
Lawton, OK 73505-6332
Phone (580) 585-5511

Other names 1

  • LCHC Cache Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190719000794 OK Part A Provider - Federally Qualified Health Center (FQHC) 2668373689 Practice locations: Cache, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285294298. Details of each certification follow.

Federally qualified health center certification: CCN 371943

Legal name
COMANCHE COUNTY HOSPITAL AUTHORITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 22, 2019
Last certification
Jul 22, 2019
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Nov 28, 2006 in OK
Enrollment address
512 W C Ave
Cache, OK 73527-9491

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
37D2170716LCHC Cache Clinic512 C Ave, Cache, OK 73527Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Comanche Co Mem Dba Sou41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

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
George W Kruger Individual Corporate Director Aug 3, 2015
Jervis Jackson Individual Corporate OfficerBoard Member Oct 1, 2022
Amber Murphy Individual Corporate OfficerBoard Secretary Mar 1, 2021
Christine James Individual Corporate OfficerBoard Member Oct 1, 2023
Kathleen Cooper Individual Corporate OfficerBoard Vice Chair Aug 1, 2019
Richard Rogalski Individual Corporate OfficerBoard Member Sep 1, 2015
Brett Simms Individual Corporate OfficerBoard Member Nov 1, 2023
Brent L Smith Individual Corporate Director Apr 1, 2014
W-2 Managing Employee Apr 1, 2014
Rosemary Bellino Hall Individual Corporate OfficerBoard Member May 1, 2020
Yolanda Allen Individual Corporate OfficerBoard Member Mar 1, 2024
Debra Johnson Individual Corporate OfficerBoard Member May 1, 2020
Kim Rogalski Individual Corporate OfficerBoard Chair Aug 1, 2019
Brenda Spencer Ragland Individual Corporate OfficerBoard Treasurer Jul 1, 2011
Sean McAvoy Individual Corporate Director Feb 4, 2013
W-2 Managing Employee Feb 4, 2013

All facility ownership & control disclosures 10

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 Medicine ParkMedicine Park, OK, CCN 371975 Federally qualified health center Operational/Managerial Control Jun 1, 2020
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

NPI Registry JSON

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1285294298",
    "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": "735056332",
            "telephone_number": "580-585-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 W C AVE",
            "city": "CACHE",
            "state": "OK",
            "postal_code": "735279491",
            "telephone_number": "580-699-7355",
            "fax_number": "580-699-7362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCHC Cache",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cache, OK

Sources for this page

Verify at the official NPI Registry.