Healthcare Provider Details

I. General information

NPI: 1639304181
Provider Name (Legal Business Name): MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S PARK DR
BROKEN BOW OK
74728-5330
US

IV. Provider business mailing address

1301 E LINCOLN RD
IDABEL OK
74745-7300
US

V. Phone/Fax

Practice location:
  • Phone: 580-584-3449
  • Fax: 580-584-3451
Mailing address:
  • Phone: 580-208-3100
  • Fax: 580-208-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. RAY B WHITMORE JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 580-208-3104