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3201 W Gore Blvd Suite 301 Lawton OK 73505-6378 | |
(580) 248-8225 | |
(580) 248-8919 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3201 W Gore Blvd, Lawton, Oklahoma |
Authorized Official Name and Position | Julie Kilgore (CREDENTIALING) |
Authorized Official Contact | 5805855443 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3401 W Gore Blvd Lawton OK 73505-6332 Ph: (580) 585-5443 | 3201 W Gore Blvd Suite 301 Lawton OK 73505-6378 Ph: (580) 248-8225 |
NPI Number | 1245254705 |
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Provider Enumeration Date | 07/27/2006 |
Last Update Date | 12/14/2020 |
Medicare PECOS PAC ID | 2668373689 |
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Medicare Enrollment ID | O20210112000517 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245254705 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 11906 (Oklahoma) | Secondary |
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 |