Provider Demographics
NPI:1184838203
Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Other - Org Name:MCCURTAIN MEMORIAL HOSPITAL PART B
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENA
Authorized Official - Middle Name:CHEREE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-208-3103
Mailing Address - Street 1:1301 E LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7300
Mailing Address - Country:US
Mailing Address - Phone:580-286-7623
Mailing Address - Fax:580-208-3199
Practice Address - Street 1:1301 E LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7300
Practice Address - Country:US
Practice Address - Phone:580-286-7623
Practice Address - Fax:580-208-3199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700920BMedicaid
OKM37004801Medicare ID - Type UnspecifiedMEDICARE PART B
OK100700920BMedicaid