Healthcare Provider Details

I. General information

NPI: 1104868207
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD
LAWTON OK
73505-6300
US

IV. Provider business mailing address

PO BOX 129
LAWTON OK
73502-0129
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8699
  • Fax: 580-585-5453
Mailing address:
  • Phone: 580-355-8620
  • Fax: 580-250-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL SEGLER
Title or Position: CEO
Credential:
Phone: 580-585-5511