Healthcare Provider Details

I. General information

NPI: 1740216993
Provider Name (Legal Business Name): CIMARRON SURGICAL CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E MAIN ST SUITE 3
CUSHING OK
74023-2905
US

IV. Provider business mailing address

2340 E MAIN ST SUITE 3
CUSHING OK
74023-2905
US

V. Phone/Fax

Practice location:
  • Phone: 918-509-0030
  • Fax:
Mailing address:
  • Phone: 918-509-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0082
License Number StateOK

VIII. Authorized Official

Name: FRANK L HUBBARD
Title or Position: OWNER
Credential: DO
Phone: 918-225-6904