Organization
COMANCHE COUNTY HEALTHCARE CORP
Active
Other names
MNT DIABETES SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT SMITH (CFO)
(580) 355-8620
Entity
Organization
Contact information
Practice address
3201 W GORE BLVD, SUITE 103, LAWTON, OK 73505-6378
(580) 250-6407
(580) 355-5893
Mailing address
PO BOX 785, LAWTON, OK 73502-0785
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100810030L
—
OK
Enumeration date
10/15/2008
Last updated
05/08/2015
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