Healthcare Provider Details

I. General information

NPI: 1699409052
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 SW CORNELL AVE
LAWTON OK
73505-7121
US

IV. Provider business mailing address

1202 NW ARLINGTON AVE
LAWTON OK
73507-6537
US

V. Phone/Fax

Practice location:
  • Phone: 580-248-0696
  • Fax:
Mailing address:
  • Phone: 580-280-4440
  • Fax: 580-248-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics 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: SEAN MCAVOY
Title or Position: EXECUTIVE DIRECTOR OF PRIMARY CARE
Credential:
Phone: 580-355-5242