MEDICARE: COMANCHE COUNTY HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000370056001	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104868207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMANCHE COUNTY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73502-0129
Country	:	US
Telephone Number	:	580-355-8620
Fax Number	:	580-250-6458

Provider Business Practice Location Address
First Line	:	3401 W GORE BLVD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6300
Country	:	US
Telephone Number	:	580-355-8699
Fax Number	:	580-585-5453

Authorized Official
Title or Position	:	CEO
Name	:	MR. RANDALL SEGLER
Credential	:
Telephone Number	:	580-585-5511

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/23/2013

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Directions to “COMANCHE COUNTY HOSPITAL AUTHORITY ” Practice Location

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