Comanche County Healthcare
Organization Active NPI Physical Medicine & Rehabilitation Physician · Lawton, OK
NPI 1649290644 · NPPES record last updated May 8, 2015
Key facts
- NPI
- 1649290644
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- 4083 (OK)
- Legal business name
- COMANCHE COUNTY HEALTHCARE
- Practice address
- 3201 W Gore Blvd
Ste 104
Lawton, OK 73505-6378 - Phone
- (580) 250-6659
- Fax
- (580) 250-5249
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Brent Smith
- Title
- Cfo
- Phone
- (580) 355-8620
Other NPIs on the same Medicare enrollment 39
Corporate family (same tax ID) 33
Practitioners 7
-
Jessica Caitlin Clayton, PMHNP
-
Pradeep Kumar Mada, M.D.
-
Aisha Mohammed, MD
-
Robert A Abernathy, M.D.
-
Mohammad Bilal Chaudhary, M.D.
-
Shamsuddin B Lalani, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Troy L Harden DO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | 4083 | OK | Yes |
Addresses
Primary practice location
3201 W Gore Blvd
Ste 104
Lawton, OK 73505-6378
Mailing address
PO Box 785
Lawton, OK 73502
Phone (580) 357-9984
Other names
- MEMORIAL MEDICAL GROUP PHYSICAL MEDICINE & REHABILITATION
Other providers in Lawton, OK
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare
- Comanche County Healthcare Corp
- Comanche County Healthcare Corp
All providers in Lawton, OK · Physical Medicine & Rehabilitation Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.