Healthcare Provider Details

I. General information

NPI: 1891195590
Provider Name (Legal Business Name): COMANCHE COUNTY HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 W GORE BLVD SUITE A2
LAWTON OK
73505-6016
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-0575
  • Fax: 580-248-1725
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENT SMITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 580-355-8620