Healthcare Provider Details

I. General information

NPI: 1992183099
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W GORE BLVD SUITE 6
LAWTON OK
73505-6310
US

IV. Provider business mailing address

PO BOX 2309 SECTION 2
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6525
  • Fax:
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: CFO
Credential:
Phone: 580-510-7070