Healthcare Provider Details

I. General information

NPI: 1588351407
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SW LEE BLVD
LAWTON OK
73501-5711
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6541
  • Fax: 580-250-6543
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BRENT SMITH
Title or Position: CEO
Credential:
Phone: 580-585-5522