Healthcare Provider Details

I. General information

NPI: 1609041136
Provider Name (Legal Business Name): CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROADWAY ST
ALTUS OK
73521-5702
US

IV. Provider business mailing address

104 NW 31ST ST
LAWTON OK
73505-6100
US

V. Phone/Fax

Practice location:
  • Phone: 580-480-4400
  • Fax: 580-480-4416
Mailing address:
  • Phone: 580-536-2121
  • Fax: 580-536-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. JAMES L HOOTON
Title or Position: CHEIF OPERATING OFFICER
Credential:
Phone: 580-536-2121