Comanche County Hospital Authority Southwest Radiology

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

COMANCHE COUNTY HOSPITAL AUTHORITY SOUTHWEST RADIOLOGY

Practice address

11447 Dutch Iris Dr
Riverview, FL 33578-3728

Phone

(580) 585-2717

NPI assigned

Apr 14, 2009

Last updated

Jun 7, 2013By the provider in NPPES

Organization subpart

No

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) 355-8699

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Comanche County Hospital Authority Southwest Radiology

  • Diagnostic Radiology Physician
  • Lawton, OK
  • NPI 1194996447

  O20131023001153

  Same enrollment

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1710120258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2309",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735022309",
            "telephone_number": "800-945-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11447 DUTCH IRIS DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783728",
            "telephone_number": "580-585-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HOSPITAL AUTHORITY SOUTHWEST RADIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-14",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-355-8699"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "115285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Riverview, FL
• Providers in Riverview, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; 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.