Provider Demographics
NPI:1285665836
Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Other - Org Name:MCCURTAIN MEMORIAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:580-208-3104
Mailing Address - Street 1:1301 LINCOLN RD
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:580-208-3100
Mailing Address - Fax:580-208-3199
Practice Address - Street 1:1301 EAST 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:580-208-3100
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:2006-07-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7071251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377169Medicare ID - Type UnspecifiedHOME HEALTH