Provider Demographics
NPI:1407937220
Name:STILLWATER MEDICAL CENTER AUTHORITY
Entity Type:Organization
Organization Name:STILLWATER MEDICAL CENTER AUTHORITY
Other - Org Name:CIMARRON MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-377-9735
Mailing Address - Street 1:1200 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5477
Mailing Address - Country:US
Mailing Address - Phone:405-377-9735
Mailing Address - Fax:405-372-3890
Practice Address - Street 1:1200 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-377-9735
Practice Address - Fax:405-372-3890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STILLWATER MEDICAL CENTER AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699950BMedicaid
OK100699950BMedicaid