MEDICARE: COMANCHE COUNTY HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy	3-4456	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2074707	OTHER		PK

General Provider Information

NPI Number	:	1427130947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMANCHE COUNTY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	3201 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6378
Country	:	US
Telephone Number	:	580-585-5401
Fax Number	:	580-510-7033

Provider Business Practice Location Address
First Line	:	3201 W GORE BLVD STE A
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6350
Country	:	US
Telephone Number	:	580-585-5401
Fax Number	:	580-510-7033

Authorized Official
Title or Position	:	PHRM MNG
Name	:	SETH JULIAN
Credential	:
Telephone Number	:	580-585-5401

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/23/2023

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Directions to “COMANCHE COUNTY HOSPITAL AUTHORITY ” Practice Location

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