Provider Demographics
NPI:1821528662
Name:CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Entity Type:Organization
Organization Name:CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Other - Org Name:CANCER CENTERS OF SOUTHWEST OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:HOOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-536-2121
Mailing Address - Street 1:104 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6100
Mailing Address - Country:US
Mailing Address - Phone:580-536-2121
Mailing Address - Fax:580-536-2150
Practice Address - Street 1:210 SOUTH MARY BAILEY DRIVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018
Practice Address - Country:US
Practice Address - Phone:405-222-9222
Practice Address - Fax:405-222-9221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty