Healthcare Provider Details

I. General information

NPI: 1225320898
Provider Name (Legal Business Name): COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 W GORE BLVD
LAWTON OK
73505-6319
US

IV. Provider business mailing address

924 NW 38TH ST
LAWTON OK
73505-3703
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-7665
  • Fax: 580-355-7668
Mailing address:
  • Phone: 580-355-7655
  • Fax: 580-355-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BLACKMON
Title or Position: CFO
Credential:
Phone: 580-355-8699