Healthcare Provider Details

I. General information

NPI: 1396715926
Provider Name (Legal Business Name): CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
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 TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateNULL

VIII. Authorized Official

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