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3201 W Gore Blvd Ste 203 Lawton OK 73505-6350 | |
(580) 250-6540 | |
(580) 354-5937 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3201 W Gore Blvd Ste 203, Lawton, Oklahoma |
Authorized Official Name and Position | Brent Smith (CEO) |
Authorized Official Contact | 5805855522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2309 Sec 2 Lawton OK 73502 Ph: (580) 357-9984 | 3201 W Gore Blvd Ste 203 Lawton OK 73505-6350 Ph: (580) 250-6540 |
NPI Number | 1790270502 |
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Provider Enumeration Date | 06/25/2018 |
Last Update Date | 06/25/2018 |
Medicare PECOS PAC ID | 2668373689 |
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Medicare Enrollment ID | O20181023002612 |
Identifier | Type | State | Issuer |
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1790270502 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mark W Cotton Do Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5610 Sw Lee Blvd, Lawton, OK 73505 Phone: 580-536-6600 Fax: 580-536-2427 | |
R. Brent Smith, M.d., Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4411 W Gore Blvd, Ste. B-5, Lawton, OK 73505 Phone: 580-357-0493 | |
Sooner Inpatient Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3401 W Gore Blvd, Lawton, OK 73505 Phone: 954-838-2371 |