Healthcare Provider Details

I. General information

NPI: 1376757401
Provider Name (Legal Business Name): MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E LINCOLN ROAD
IDABEL OK
74745-7300
US

IV. Provider business mailing address

1301 E LINCOLN ROAD
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 TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

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