Healthcare Provider Details

I. General information

NPI: 1548648579
Provider Name (Legal Business Name): COMANCHE COUNTY HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 31ST ST 2ND FLOOR
LAWTON OK
73505-6100
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-3671
  • Fax: 580-357-1256
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number299
License Number StateOK

VIII. Authorized Official

Name: BRENT SMITH
Title or Position: CFO
Credential:
Phone: 580-355-8620