Healthcare Provider Details

I. General information

NPI: 1821318668
Provider Name (Legal Business Name): REYNOLDS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 SW LEE BLVD FRONTIER MEDICAL HOME-SILL
LAWTON OK
73505-9695
US

IV. Provider business mailing address

3009 NW WILSON STREET ATTN MCUA-PAD-PF - BILLING OFFICE
FORT SILL OK
73503
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-2800
  • Fax:
Mailing address:
  • Phone: 580-458-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES CHITTUM
Title or Position: UBO MANAGER
Credential:
Phone: 580-558-2793