NPIMap

Organization Active NPI

Lauderdale Community Hospital LLC

Doing business as Lauderdale Community Hospital

  • Emergency Care Clinic/Center
  • Ripley, TN
National Provider Identifier
1962034272
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
Legal business name
LAUDERDALE COMMUNITY HOSPITAL LLC
Doing business as
Lauderdale Community Hospital
Practice address
340 Asbury Ave
Ripley, TN 38063-5577
Phone
(731) 221-2200
Fax
(731) 221-2499
NPI assigned
Feb 5, 2020
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Darrel Morris
Title
Coo
Phone
(918) 527-1234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Emergency Care Clinic/Center 261QE0002X Primary

Addresses

Primary practice location

340 Asbury Ave
Ripley, TN 38063-5577

Mailing address

340 Asbury Ave
Ripley, TN 38063-5577
Phone (731) 221-2200

Other names 1

  • Lauderdale Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210422000338 TN Part B Supplier - Clinic/Group Practice 9830505023 Receives reassigned benefits from 50 practitioners
1 other NPI on this enrollment
Practice locations: Ripley, TN

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 1

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

National Provider Directory

National Provider Directory

Locations

340 Asbury Ave
Ripley, TN 38063
Phone (731) 221-2200

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1962034272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 ASBURY AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380635577",
            "telephone_number": "731-221-2200",
            "fax_number": "731-221-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 ASBURY AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380635577",
            "telephone_number": "731-221-2200",
            "fax_number": "731-221-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUDERDALE COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2024-06-21",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-527-1234"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lauderdale Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lauderdale Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.