NPIMap

Organization Active NPI

Medicine Lodge Memorial Hospital

Doing business as Medicine Lodge Memorial Hospital Ambulance Service

  • 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
Doing business as
Medicine Lodge Memorial Hospital Ambulance Service
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
Last updated
Jul 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X H004002 KS Primary

Addresses

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 names 1

  • Medicine Lodge Memorial Hospital Ambulance Service Doing business as

Electronic endpoints 2

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609979004. Details of each certification follow.

Hospital certification: CCN 171334

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

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

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

National Provider Directory

National Provider Directory
Tax ID family
Medicine Lodge Physicians6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 9

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

Practitioners & affiliated clinicians

Practitioners 10

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.

Affiliated clinicians 27

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

View all 27

NPI Registry JSON

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

{
    "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": [],
    "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.