Provider Demographics
NPI:1396715926
Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Entity type:Organization
Organization Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-589-0231
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-1059
Mailing Address - Country:US
Mailing Address - Phone:580-544-2501
Mailing Address - Fax:580-544-2517
Practice Address - Street 1:100 S ELLIS
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-1059
Practice Address - Country:US
Practice Address - Phone:580-544-2501
Practice Address - Fax:580-544-2517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIMARRON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X, 313M00000X
OK275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000370146001OtherBCBS
OK100700740AMedicaid
OK100700740AMedicaid