NPIMap

Organization Active NPI

Comanche County Hospital Authority

Doing business as CCMH Ambulance Services

  • Land Ambulance
  • Lawton, OK
National Provider Identifier
1770525883
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
314 Issued in OK
Legal business name
COMANCHE COUNTY HOSPITAL AUTHORITY
Doing business as
CCMH Ambulance Services
Practice address
1301 SW 30TH St
Lawton, OK 73505-7904
Phone
(580) 585-5555
Fax
(580) 355-6450
NPI assigned
Jun 12, 2006
Last updated
Apr 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Authorized official

Name
Brent L Smith
Title
Ceo
Phone
(580) 585-5511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 314 OK Primary

Addresses

Primary practice location

1301 SW 30TH St
Lawton, OK 73505-7904

Mailing address

3401 W Gore Blvd
Lawton, OK 73505-6300
Phone (580) 585-5443

Other identifiers 1

IdentifierTypeStateIssuer
100749570JMedicaidOK

Other names 1

  • CCMH AMBULANCE SERVICES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20101015000627 OK Part A Provider - Hospital 2668373689 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawton, OK; Altus, OK; Duncan, OK
O20140602001702 OK Part B Supplier - Clinic/Group Practice 2668373689 Receives reassigned benefits from 79 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawton, OK
O20160428000839 OK Part B Supplier - Clinic/Group Practice 2668373689 Receives reassigned benefits from 10 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawton, OK
O20200505001127 OK Part B Supplier - Ambulance Service Supplier 2668373689 1 other NPI on this enrollment
Practice locations: Lawton, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770525883. Details of each certification follow.

Hospital certification: CCN 370056

Legal name
COMANCHE COUNTY HOSPITAL AUTHORITY
Doing business as
MEMORIAL HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 17, 2025
Beds
265
Ownership / control type
Hospital district or authority
Most recent change of ownership
Dec 1, 2025 (1 total)
Organization structure
GovernmentNon-profit
Enrollment address
3401 W Gore Blvd
Lawton, OK 73505-6300
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 16

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

View all 16

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HealthCCN 370056 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1301 SW 30th St
Lawton, OK 73505
Phone (580) 585-5555

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
George W Kruger Individual Corporate OfficerCfo Aug 3, 2015
W-2 Managing EmployeeCfo Aug 3, 2015
Operational/Managerial ControlCfo Aug 3, 2015
Dustin J Hilliary Individual Corporate Director Jul 16, 2024
Comanche County Hospital Authority Organization, Lawton, OK Non-profit Operational/Managerial Control Jan 13, 1971
John P Zelbst Individual Corporate Officer Jul 1, 2023
Corporate Director Jul 1, 1997
Mark a Henry Individual Corporate Officer Jul 16, 2024
Corporate Director Jul 1, 2021
Brent L Smith Individual Corporate OfficerCeo Apr 1, 2014
W-2 Managing EmployeeCeo Apr 1, 2014
Operational/Managerial ControlCeo Apr 1, 2014
Natalie J Fitch Individual Corporate Officer Jul 1, 2021
Corporate Director Jan 25, 2021
Edward a Legako Individual Corporate Director May 17, 2016

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial HealthLawton, OK, CCN 37T056 Hospital Operational/Managerial Control Jan 13, 1971
Memorial HealthLawton, OK, CCN 370056 Hospital Operational/Managerial Control Jan 13, 1971
McMahon Tomlinson Nursing & Rehabilitation CenterLawton, OK, CCN 375562 Skilled nursing facility Operational/Managerial Control Jan 13, 1971
Comanche County Memorial Hospital Home Health CareLawton, OK, CCN 377070 Home health agency Operational/Managerial Control Jan 13, 1971
Comanche County Memorial Hospice and Supportive CareLawton, OK, CCN 371713 Hospice Operational/Managerial Control Jan 13, 1971
Lawton Community Health CenterLawton, OK, CCN 371846 Federally qualified health center Operational/Managerial Control Mar 6, 2008
Comanche County Hospital AuthorityLawton, OK, CCN 371962 Federally qualified health center Operational/Managerial Control Jan 13, 1971
LCHC Medicine ParkMedicine Park, OK, CCN 371975 Federally qualified health center Operational/Managerial Control Jun 1, 2020
LCHC Family Continuity ClinicLawton, OK, CCN 371017 Federally qualified health center Operational/Managerial Control (100%) Aug 29, 2023
MMG Snyder Family Medical ClinicSnyder, OK, CCN 373443 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1996

Practitioners & affiliated clinicians

Affiliated clinicians 441

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 441

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1770525883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056300",
            "telephone_number": "580-585-5443",
            "fax_number": "580-585-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 SW 30TH ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735057904",
            "telephone_number": "580-585-5555",
            "fax_number": "580-355-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-585-5511"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OK",
            "license": "314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100749570J",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH AMBULANCE SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.