NPIMap

Organization Active NPI

Comanche County Healthcare Corporation

Doing business as MMG Urology

  • Urology Physician
  • Lawton, OK
National Provider Identifier
1154345619
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
19658 Issued in OK
Legal business name
COMANCHE COUNTY HEALTHCARE CORPORATION
Doing business as
MMG Urology
Practice address
3201 W Gore Blvd
Suite 201
Lawton, OK 73505
Phone
(580) 357-2261
Fax
(580) 354-5990
NPI assigned
Jul 27, 2006
Last updated
Jul 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brent Smith
Title
Cfo
Phone
(580) 355-8620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 19658 OK Primary

Addresses

Primary practice location

3201 W Gore Blvd
Suite 201
Lawton, OK 73505

Mailing address

PO Box 785
Lawton, OK 73502
Phone (580) 357-9984

Other identifiers 1

IdentifierTypeStateIssuer
100810030LMedicaidOK

Other names 1

  • MMG Urology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000742 OK Part B Supplier - Clinic/Group Practice 0749192433 Receives reassigned benefits from 166 practitioners
40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawton, OK; Oklahoma City, OK; Pawhuska, OK; Snyder, OK; Tahlequah, OK; The Village, OK; Edmond, OK; Frederick, OK

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Clinic34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1154345619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 785",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73502",
            "telephone_number": "580-357-9984",
            "fax_number": "580-357-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W GORE BLVD",
            "address_2": "SUITE 201",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73505",
            "telephone_number": "580-357-2261",
            "fax_number": "580-354-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HEALTHCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-355-8620"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OK",
            "license": "19658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100810030L",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMG Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.