Provider Demographics
NPI:1639304181
Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Other - Org Name:MEMORIAL NORTH HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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 1:510 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5330
Practice Address - Country:US
Practice Address - Phone:580-584-3449
Practice Address - Fax:580-584-3451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-27
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKM37004801Medicare PIN