Provider Demographics
NPI:1427130947
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:PHRM MNG
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-585-5401
Mailing Address - Street 1:3201 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6378
Mailing Address - Country:US
Mailing Address - Phone:580-585-5401
Mailing Address - Fax:580-510-7033
Practice Address - Street 1:3201 W GORE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6350
Practice Address - Country:US
Practice Address - Phone:580-585-5401
Practice Address - Fax:580-510-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3-4456333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749570RMedicaid
2074707OtherPK