NPIMap

Organization Active NPI

McCurtain Memorial Medical Management, Inc.

  • Certified Registered Nurse Anesthetist
  • Idabel, OK
National Provider Identifier
1184838203
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Practice address
1301 E Lincoln Road
Idabel, OK 74745-7300
Phone
(580) 286-7623
Fax
(580) 208-3199
NPI assigned
May 9, 2007
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kena Cheree Allen
Title
Cfo
Phone
(580) 208-3103

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X
Obstetrics & Gynecology Physician 207V00000X
Diagnostic Radiology Physician 2085R0202X
Diagnostic Ultrasound Physician 2085U0001X

Addresses

Primary practice location

1301 E Lincoln Road
Idabel, OK 74745-7300

Mailing address

1301 E Lincoln Road
Idabel, OK 74745-7300
Phone (580) 286-7623

Other identifiers 1

IdentifierTypeStateIssuer
100700920BMedicaidOK

Other names 1

  • McCurtain Memorial Hospital Part B Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040626000315 OK Part B Supplier - Clinic/Group Practice 8022926252 Receives reassigned benefits from 59 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Idabel, OK; Broken Bow, OK
O20210208002374 OK Part A Provider - Rural Health Clinic 8022926252 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valliant, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184838203. Details of each certification follow.

Rural health clinic certification: CCN 378553

Legal name
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Doing business as
MCCURTAIN MEMORIAL CLINIC/VALLIANT HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2022
Last certification
Jul 1, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 5, 1975 in OK
Enrollment address
101 E Terri Dr
Valliant, OK 74764-6801
Related CCNs
371342

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
MCC Mem Med SVC

Locations

3959 Broadway
Ste BHN7702
New York, NY 10032

510 N Park Dr
Broken Bow, OK 74728

1315 S Lynn Ln
Idabel, OK 74745
Phone (580) 286-2947

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lindsey Erin Campbell Individual Corporate DirectorBoard Member Nov 18, 2021
Brian Ashley Whitfield Individual Corporate Officer Mar 24, 2022
Julie Matthews Individual W-2 Managing EmployeeController Mar 23, 2022
Johnnie Meredith Individual Corporate DirectorBoard Vice President Aug 17, 2017
Kena C Allen Individual Corporate OfficerChief Financial Officer Mar 6, 2022
Lane Manginell Individual Corporate OfficerChief Operating Officer Feb 19, 2023
McCurtain Memorial Medical Management, Inc. Organization, Idabel, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2021 100%
Operational/Managerial Control Apr 1, 2021 100%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1184838203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 E LINCOLN ROAD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747457300",
            "telephone_number": "580-286-7623",
            "fax_number": "580-208-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E LINCOLN ROAD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747457300",
            "telephone_number": "580-286-7623",
            "fax_number": "580-208-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.",
        "enumeration_date": "2007-05-09",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "KENA",
        "authorized_official_middle_name": "CHEREE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "580-208-3103"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700920B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCurtain Memorial Hospital Part B",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "McCurtain Memorial Hospital Part B",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Idabel, OK

Sources for this page

Verify at the official NPI Registry.