Healthcare Provider Details

I. General information

NPI: 1629020177
Provider Name (Legal Business Name): MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E LINCOLN RD
IDABEL OK
74745-7300
US

IV. Provider business mailing address

1301 E LINCOLN RD
IDABEL OK
74745-7300
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number2202
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2202
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7071
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2202
License Number StateOK

VIII. Authorized Official

Name: RAY B. WHITMORE JR.
Title or Position: CFO
Credential:
Phone: 580-208-3104