Provider Demographics
NPI:1164493904
Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Entity Type:Organization
Organization Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Other - Org Name:CIMARRON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-589-0231
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-1059
Mailing Address - Country:US
Mailing Address - Phone:580-544-2501
Mailing Address - Fax:580-544-2517
Practice Address - Street 1:100 S ELLIS
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-1059
Practice Address - Country:US
Practice Address - Phone:580-544-2501
Practice Address - Fax:580-544-2517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-30
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000370146001OtherBCBS
400522117Medicare ID - Type Unspecified