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General NPI Number Information
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NPI Number | 1710120258
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Entity Type | Organization
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Legal Business Name | COMANCHE COUNTY HOSPITAL AUTHORITY SOUTHWEST RADIOLOGY
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 11447 DUTCH IRIS DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-3728
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Country | US
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Telephone | 580-585-2717
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2309
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City | LAWTON
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State | OK
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Zip | 73502-2309
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Country | US
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Telephone | 800-945-2455
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DAVID BLACKMON
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Credential |
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Telephone | 580-355-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 115285
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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