Provider Demographics
NPI:1588876973
Name:MCCURTAIN FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:MCCURTAIN FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGRUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-584-7210
Mailing Address - Street 1:800 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-2146
Mailing Address - Country:US
Mailing Address - Phone:580-584-7210
Mailing Address - Fax:580-584-7213
Practice Address - Street 1:110 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3902
Practice Address - Country:US
Practice Address - Phone:580-584-7210
Practice Address - Fax:580-584-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200015540CMedicaid
OK=========OtherTAX ID