NPIMap

Organization Active NPI

Lawrence Memorial Health Foundation Inc.

Doing business as Lawrence Memorial Physician Group

  • Critical Access Hospital
  • Walnut Ridge, AR
National Provider Identifier
1962626770
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
AR38420 Issued in AR
Legal business name
LAWRENCE MEMORIAL HEALTH FOUNDATION INC.
Doing business as
Lawrence Memorial Physician Group
Practice address
1309 W Main St
Walnut Ridge, AR 72476-1430
Phone
(870) 886-1252
Fax
(870) 886-3388
NPI assigned
Apr 12, 2007
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Mrs. Vanessa K Wagner
Title
Cfo
Phone
(870) 886-1263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X AR38420 AR Primary

Addresses

Primary practice location

1309 W Main St
Walnut Ridge, AR 72476-1430

Mailing address

1309 W Main St
Walnut Ridge, AR 72476-1430
Phone (870) 886-1252

Other identifiers 1

IdentifierTypeStateIssuer
103154002MedicaidAR

Other names 1

  • Lawrence Memorial Physician Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Lawrence.Memorial@lmh.hin.us Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191030002298 AR Part B Supplier - Clinic/Group Practice 9436305836 Receives reassigned benefits from 20 practitioners
Practice locations: Walnut Ridge, AR

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Lawrence Mem HLTH FNDT Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1962626770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761430",
            "telephone_number": "870-886-1252",
            "fax_number": "870-886-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761430",
            "telephone_number": "870-886-1252",
            "fax_number": "870-886-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE MEMORIAL HEALTH FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-886-1263",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR38420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103154002",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lawrence.Memorial@lmh.hin.us",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1309 W Main St",
            "city": "Walnut Ridge",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724761430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lawrence Memorial Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Ridge, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.