Healthcare Provider Details

I. General information

NPI: 1891341186
Provider Name (Legal Business Name): MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 N US HIGHWAY 259
BROKEN BOW OK
74728-7086
US

IV. Provider business mailing address

1301 E LINCOLN RD
IDABEL OK
74745-7300
US

V. Phone/Fax

Practice location:
  • Phone: 580-494-6562
  • Fax: 580-494-6566
Mailing address:
  • Phone: 580-286-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENA CHEREE ALLEN
Title or Position: CFO
Credential:
Phone: 580-208-3103