Provider Demographics
NPI:1356506109
Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Other - Org Name:SOUTHEAST OKLAHOMA SURGICAL SERVICES
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 E 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 1:1425 E LINCOLN RD
Practice Address - Street 2:SUITE A-6
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-2947
Practice Address - Fax:580-286-8287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKM37004801Medicare PIN