Provider Demographics
NPI:1952550659
Name:CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Entity Type:Organization
Organization Name:CANCER CENTERS OF SOUTHWEST OKLAHOMA, LLC
Other - Org Name:SOUTHWEST OKLAHOMA CANCER CENTER, L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND MANAGER
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 1:3401 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6332
Mailing Address - Country:US
Mailing Address - Phone:580-585-5406
Mailing Address - Fax:
Practice Address - Street 1:3401 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6332
Practice Address - Country:US
Practice Address - Phone:580-585-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology