NPIMap

Organization Active NPI

Medicine Lodge Memorial Hospital

  • Ambulance
  • Medicine Lodge, KS
National Provider Identifier
1609979004
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
H004002 Issued in KS
Legal business name
MEDICINE LODGE MEMORIAL HOSPITAL
Practice address
710 N Walnut St
Drawer 'C'
Medicine Lodge, KS 67104-1019
Phone
(620) 886-3771
Fax
(620) 886-5012
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Ashley Taylor
Title
Administrator
Phone
(620) 886-3771

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 5

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

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

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 27

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

View all 27

Care Compare: Hospital

Medicare Care Compare
Listed as
Medicine Lodge Memorial HospitalCCN 171334
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Medicare participation

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

Hospital certification: CCN 171334

Medicare enrollment files
Legal name
MEDICINE LODGE MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2001
Last certification
Apr 25, 2016
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
710 N Walnut St
Medicine Lodge, KS 67104-1019

All disclosed owners & managing parties 9

Medicare enrollment files

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

NameRoleSinceShare
Lennes Rankin Individual Corporate Director Mar 14, 2006
Brandon Phipps Individual Corporate Director Nov 1, 2016
Betty Buell Individual Corporate Director Feb 1, 1986
Jennifer Bowe Individual Corporate Officer Jul 1, 2015
W-2 Managing Employee Jul 1, 2015
Great Plains Health Alliance Inc Organization, Wichita, KS Management services company Operational/Managerial Control Jan 1, 1984
Darryl Honas Individual Corporate Director May 3, 2021
Ashley Taylor Individual Corporate OfficerCeo Apr 1, 2021
W-2 Managing Employee Apr 1, 2021
George W Palmer Individual Corporate Director Sep 1, 2016
Curt Colson Individual Corporate OfficerCeo Apr 1, 2022

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20061104000671 KS Part a Provider - Critical Access Hospital 6901879410 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medicine Lodge, KS

National Provider Directory

National Provider Directory
Tax ID family
Medicine Lodge Surgery CL (6 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X H004002 KS Primary

Addresses

NPPES NPI Registry

Primary practice location

710 N Walnut St
Drawer 'C'
Medicine Lodge, KS 67104-1019

Mailing address

710 N Walnut St
Drawer 'C'
Medicine Lodge, KS 67104-1019
Phone (620) 886-3771

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
100092110DMedicaidKS

Other names 1

NPPES NPI Registry
  • Medicine Lodge Memorial Hospital Ambulance Service Doing business as

Electronic endpoints 2

NPPES NPI Registry
TypeEndpointUseAffiliation
Direct Messaging Address MedicineLodge.Clinic@MedicineLodge-GPHA.cernerdirect.com Direct
Direct Messaging Address MedicineLodge.Hospital@MedicineLodge-GPHA.cernerdirect.com Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 2, 2024.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1609979004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N WALNUT ST",
            "address_2": "DRAWER 'C'",
            "city": "MEDICINE LODGE",
            "state": "KS",
            "postal_code": "671041019",
            "telephone_number": "620-886-3771",
            "fax_number": "620-886-5012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N WALNUT ST",
            "address_2": "DRAWER 'C'",
            "city": "MEDICINE LODGE",
            "state": "KS",
            "postal_code": "671041019",
            "telephone_number": "620-886-3771",
            "fax_number": "620-886-5012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE LODGE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "620-886-3771",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "KS",
            "license": "H004002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092110D",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MedicineLodge.Clinic@MedicineLodge-GPHA.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Medicine Lodge Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "710 N Walnut St",
            "city": "Medicine Lodge",
            "state": "KS",
            "country_code": "US",
            "postal_code": "671041019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MedicineLodge.Hospital@MedicineLodge-GPHA.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Medicine Lodge Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "710 N Walnut St",
            "city": "Medicine Lodge",
            "state": "KS",
            "country_code": "US",
            "postal_code": "671041019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Medicine Lodge Memorial Hospital Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicine Lodge Memorial Hospital Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medicine Lodge, KS

Sources for this page

Verify at the official NPI Registry.