MEDICARE: MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	273R00000X	Psychiatric Hospital Unit	2202	OK
3	275N00000X	Medicare Defined Swing Bed Hospital Unit	2202	OK
4	251E00000X	Home Health Agency	7071	OK
5	261QP2300X	Primary Care Clinic/Center
6	261QR0200X	Radiology Clinic/Center
7	261QM2500X	Medical Specialty Clinic/Center
8	367500000X	Certified Registered Nurse Anesthetist
9	261QE0002X	Emergency Care Clinic/Center
10	282NR1301X	Rural Acute Care Hospital	2202	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CD0496	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9R049	OTHER	BCBS AR

General Provider Information

NPI Number	:	1629020177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	1301 E LINCOLN RD
Second Line	:
City	:	IDABEL
State	:	OK
Zip	:	74745-7300
Country	:	US
Telephone Number	:	580-208-3100
Fax Number	:	580-208-3199

Provider Business Practice Location Address
First Line	:	1301 E LINCOLN RD
Second Line	:
City	:	IDABEL
State	:	OK
Zip	:	74745-7300
Country	:	US
Telephone Number	:	580-208-3100
Fax Number	:	580-208-3199

Authorized Official
Title or Position	:	CFO
Name	:	RAY B. WHITMORE JR.
Credential	:
Telephone Number	:	580-208-3104

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/06/2009

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