Provider Demographics
NPI:1285181610
Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Other - Org Name:CCMH AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-585-5511
Mailing Address - Street 1:3401 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6300
Mailing Address - Country:US
Mailing Address - Phone:580-585-5443
Mailing Address - Fax:580-585-5553
Practice Address - Street 1:129 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-1461
Practice Address - Country:US
Practice Address - Phone:580-585-5555
Practice Address - Fax:580-355-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport