Healthcare Provider Details

I. General information

NPI: 1164493904
Provider Name (Legal Business Name): CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/27/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ELLIS
BOISE CITY OK
73933-1059
US

IV. Provider business mailing address

PO BOX 1059
BOISE CITY OK
73933-1059
US

V. Phone/Fax

Practice location:
  • Phone: 580-544-2501
  • Fax: 580-544-2517
Mailing address:
  • Phone: 580-544-2501
  • Fax: 580-544-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN GLEASON
Title or Position: CEO
Credential:
Phone: 580-589-0231