MEMORIAL MEDICAL GROUP SURGERY – NPI #1558472506
Surgery

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

MEMORIAL MEDICAL GROUP SURGERY is a surgeon located in LAWTON, OK. NPPES has assigned the NPI number 1558472506 to MEMORIAL MEDICAL GROUP SURGERY on August 31, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “MEMORIAL MEDICAL GROUP SURGERY” is a dba name, the actual legal business name for this organization is COMANCHE COUNTY HEALTHCARE CORP. The primary taxonomy selected by this provider is 2086S0129X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Vascular Surgery

The NPI profile was previously updated about 11 years ago on May 08, 2015. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MEMORIAL MEDICAL GROUP SURGERY below.

NPI Profile for
COMANCHE COUNTY HEALTHCARE CORP

NPI Number
1558472506
Enumeration Date

(about 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
COMANCHE COUNTY HEALTHCARE CORP
Doing Business As (dba): MEMORIAL MEDICAL GROUP SURGERY
Primary location
110 NW 31ST ST
3RD FLOOR
LAWTON, OK 73505-6100
Phone: (580) 510-7042 Fax: (580) 510-7044
Mailing address
PO BOX 785
LAWTON, OK 73502-0785
Phone: (580) 357-9984 Fax: (580) 357-3277
Organization Subpart
No
Authorized Official
BRENT SMITH
CFO
Phone: (580) 355-8620
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0129X
- Surgery / Vascular Surgery (Primary)
OK 14399

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.