NPIMap

Organization Active NPI

Comanche County Healthcare Corporation

Doing business as MMG Ear, Nose and Throat Clinic

  • Otolaryngology Physician
  • Lawton, OK
National Provider Identifier
1609315308
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
COMANCHE COUNTY HEALTHCARE CORPORATION
Doing business as
MMG Ear, Nose and Throat Clinic
Practice address
3201 W Gore Blvd
Suite 103
Lawton, OK 73505-6378
Phone
(580) 250-6555
Fax
(580) 354-5942
NPI assigned
Feb 15, 2017
Last updated
Jun 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

3201 W Gore Blvd
Suite 103
Lawton, OK 73505-6378

Mailing address

PO Box 785
Lawton, OK 73502-0785
Phone (580) 357-9984

Other names 1

  • MMG Ear, Nose and Throat Clinic 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2131655MMG Ear, Nose and Throat3201 W Gore Blvd Suite 103, Lawton, OK 73505Certificate of waiverJun 4, 2027

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 7

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": "1487116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1609315308",
    "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": "735020785",
            "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 103",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056378",
            "telephone_number": "580-250-6555",
            "fax_number": "580-354-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HEALTHCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-15",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-355-8620"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMG Ear, Nose and Throat Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MMG Ear, Nose and Throat Clinic",
            "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 Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.