Healthcare Provider Details

I. General information

NPI: 1790270502
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD STE 203
LAWTON OK
73505-6350
US

IV. Provider business mailing address

PO BOX 2309 SEC 2
LAWTON OK
73502
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6540
  • Fax: 580-354-5937
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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