NPIMap

Organization Active NPI

Comanche County Healthcare Corp

Doing business as Memorial Medical Group Family Practice

  • Family Medicine Physician
  • Lawton, OK
National Provider Identifier
1659647501
Registry record updated Mar 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMANCHE COUNTY HEALTHCARE CORP
Doing business as
Memorial Medical Group Family Practice
Practice address
3201 W Gore Blvd
Ste 300
Lawton, OK 73505-6378
Phone
(580) 585-5549
Fax
(580) 354-5911
NPI assigned
Mar 26, 2012
Last updated
Mar 26, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COMANCHE COUNTY HEALTHCARE CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2012

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

Authorized official

Name
David Blackmon
Title
Cfo
Phone
(580) 355-8620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

3201 W Gore Blvd
Ste 300
Lawton, OK 73505-6378

Mailing address

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

Other names 1

  • MEMORIAL MEDICAL GROUP FAMILY PRACTICE Doing business as

National Provider Directory

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

Other organizations with this tax ID 33

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

View all 33

Locations

3201 W Gore Blvd
Ste 300
Lawton, OK 73505
Phone (580) 248-5255

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1659647501",
    "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": "STE 300",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056378",
            "telephone_number": "580-585-5549",
            "fax_number": "580-354-5911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HEALTHCARE CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMANCHE COUNTY HEALTHCARE CORP",
        "enumeration_date": "2012-03-26",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-355-8620"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL MEDICAL GROUP FAMILY PRACTICE",
            "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 Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.