NPIMap

Organization Active NPI

County of Lawrence Health Department

Doing business as Lawrence County Health Department Rural Health Clinic

  • Rural Health Clinic/Center
  • Lawrenceville, IL
National Provider Identifier
1629132410
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COUNTY OF LAWRENCE HEALTH DEPARTMENT
Doing business as
Lawrence County Health Department Rural Health Clinic
Practice address
2101 James St
Lawrenceville, IL 62439-2027
Phone
(618) 943-3302
Fax
(618) 943-6409
NPI assigned
Dec 19, 2006
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Mrs. Tina Lyden
Title
Director of Patient Accounts
Phone
(618) 943-3302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2101 James St
Lawrenceville, IL 62439-2027

Mailing address

2101 James St
Lawrenceville, IL 62439-2027
Phone (618) 943-3302

Other names 1

  • Lawrence County Health Department Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000693 IL Part B Supplier - Clinic/Group Practice 9830093723 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
Practice locations: Lawrenceville, IL
O20090921000160 IL Part A Provider - Rural Health Clinic 9830093723 Practice locations: Lawrenceville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629132410. Details of each certification follow.

Rural health clinic certification: CCN 143951

Legal name
COUNTY OF LAWRENCE HEALTH DEPARTMENT
Doing business as
LAWRENCE COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 13, 1998
Last certification
Sep 11, 2019
Ownership / control type
2A
Organization structure
GovernmentNon-profit
Enrollment address
2101 James St
Lawrenceville, IL 62439-2027

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
County of Lawrence Health Department8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Amy Marley Individual Corporate Officer Jul 1, 2019
W-2 Managing EmployeePublic Health Administrator Jul 1, 2019
Steven Mark Ramsaran Individual Corporate OfficerBoard Member Aug 15, 2014
Robert Christy Individual Corporate OfficerBoard Member Aug 15, 2014
David White Individual Corporate OfficerBoard Member Aug 15, 2014
Susan Gher Individual Corporate OfficerBoard Member Aug 15, 2014
Gerald Kelly Individual Corporate OfficerBoard Member Aug 15, 2014
Janet Kavanaugh Individual Corporate OfficerBoard Member Jul 7, 2010
Jerri Anne Boughan Individual Corporate OfficerBoard Member May 18, 2011
Daniel Shinkle Individual Corporate OfficerBoard Member Aug 15, 2014
County of Lawrence Health Department Organization, Lawrenceville, IL Operational/Managerial Control Dec 1, 1997

Owners & managing parties with NPI records 4

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1629132410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 JAMES ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392027",
            "telephone_number": "618-943-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 JAMES ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392027",
            "telephone_number": "618-943-3302",
            "fax_number": "618-943-6409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAWRENCE HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "LYDEN",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "618-943-3302",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lawrence County Health Department Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lawrence County Health Department Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, IL

Sources for this page

Verify at the official NPI Registry.