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General NPI Number Information
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NPI Number | 1760489223
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Entity Type | Organization
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Legal Business Name | LAWTON INDIAN HOSPITAL
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3002
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Country | US
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Telephone | 580-354-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3002
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Country | US
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Telephone | 580-354-5150
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Fax | 580-354-5148
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Authorized Official
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Title or Position | CEO
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Name | BRIAN WREN
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Credential |
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Telephone | 580-354-5407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 21,818
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License Number State | OK
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