Provider Demographics
NPI:1912248980
Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Entity type:Organization
Organization Name:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENA
Authorized Official - Middle Name:CHEREE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-208-3103
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:580-208-3103
Mailing Address - Fax:580-208-3199
Practice Address - Street 1:102 E TERRI DR
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-6801
Practice Address - Country:US
Practice Address - Phone:580-933-9025
Practice Address - Fax:580-933-9027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700920BMedicaid
OK100700920BMedicaid