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Organization Active NPI

Clinton Hospital Authority

Doing business as Clinton Regional Hospital

  • Family Medicine Physician
  • Clinton, OK
National Provider Identifier
1528812237
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLINTON HOSPITAL AUTHORITY
Doing business as
Clinton Regional Hospital
Practice address
100 N 30TH St
Clinton, OK 73601-3117
Phone
(580) 547-5128
Fax
(580) 547-5011
NPI assigned
Apr 17, 2024
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINTON HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Len Lacefield
Title
Ceo
Phone
(405) 454-6058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

100 N 30TH St
Clinton, OK 73601-3117

Mailing address

PO Box 1177
Clinton, OK 73601-1177
Phone (580) 323-0261

Other names 1

  • Clinton Regional Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240530000462 OK Part B Supplier - Clinic/Group Practice 5092163873 Receives reassigned benefits from 26 practitioners
Practice locations: Clinton, OK

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Clinton Regional Hospital

Member organizations 1

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

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Clinton Regional HospitalClinton, OK, CCN 370784 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1528812237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1177",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "736011177",
            "telephone_number": "580-323-0261",
            "fax_number": "580-323-3546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 30TH ST",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "736013117",
            "telephone_number": "580-547-5128",
            "fax_number": "580-547-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINTON HOSPITAL AUTHORITY",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "LACEFIELD",
        "authorized_official_first_name": "LEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-454-6058"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinton Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, OK

Sources for this page

Verify at the official NPI Registry.