1174545834 NPI number — COMANCHE COUNTY HEALTHCARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174545834 NPI number — COMANCHE COUNTY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMANCHE COUNTY HEALTHCARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAWTON PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174545834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-357-9984
Provider Business Mailing Address Fax Number:
580-357-3277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 W GORE BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-250-5824
Provider Business Practice Location Address Fax Number:
580-248-1964
Provider Enumeration Date:
07/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLACKMON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
580-355-8620

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  16952 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)