Provider Demographics
NPI:1740377993
Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-585-5511
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0129
Mailing Address - Country:US
Mailing Address - Phone:580-355-8620
Mailing Address - Fax:580-250-6458
Practice Address - Street 1:602 SE WALLOCK ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-5444
Practice Address - Country:US
Practice Address - Phone:580-355-1512
Practice Address - Fax:580-355-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2237261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
000370056001OtherBLUE CROSS BLUE SHIELD
=========001OtherCHAMPUS