NPIMap

Organization Active NPI

McCurtain Memorial Medical Management, Inc

Doing business as McCurtain Memorial Urgent Care Clinic

  • Rural Health Clinic/Center
  • Broken Bow, OK
National Provider Identifier
1891341186
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC
Doing business as
McCurtain Memorial Urgent Care Clinic
Practice address
8901 N US Highway 259
Broken Bow, OK 74728-7086
Phone
(580) 494-6562
Fax
(580) 494-6566
NPI assigned
Aug 13, 2019
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INCAs 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

8901 N US Highway 259
Broken Bow, OK 74728-7086

Mailing address

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

Other names 1

  • McCurtain Memorial Urgent Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191001001683 OK Part A Provider - Rural Health Clinic 8022926252 Practice locations: Broken Bow, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891341186. Details of each certification follow.

Rural health clinic certification: CCN 378558

Legal name
MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC.
Doing business as
MCCURTAIN MEMORIAL URGENT CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 30, 2022
Last certification
Jun 30, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 5, 1975 in OK
Enrollment address
8901 N US Highway 259
Broken Bow, OK 74728-7086
Related CCNs
371342

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

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
MCC Mem Med Services16 organizations share this tax ID, including this one
Part of
MCC Mem Med Services

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Ownership & related parties

All disclosed owners & managing parties 8

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 Director Nov 18, 2021
Brian Ashley Whitfield Individual Corporate Officer Mar 6, 2022
Jack Peterson Individual W-2 Managing Employee Mar 1, 2022
Kendra Gross Individual Corporate Director Jun 25, 2020
Julie Matthews Individual W-2 Managing Employee Mar 6, 2022
Johnnie Meredith Individual Corporate Director Aug 17, 2017
Kena C Allen Individual Corporate Officer Mar 6, 2022
W-2 Managing Employee Jul 1, 2019
McCurtain Memorial Medical Management, Inc. Organization, Idabel, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2019 100%
Operational/Managerial Control Jul 1, 2019 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McCurtain Memorial HospitalIdabel, OK, CCN 371342 Hospital 5% Or Greater Direct Ownership Interest (100%) May 5, 1975
McCurtain Memorial HospitalIdabel, OK, CCN 37Z342 Hospital 5% Or Greater Direct Ownership Interest (100%) May 5, 1975
McCurtain Memorial Rural Health Clinic IdabelIdabel, OK, CCN 378554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 2019
Jul 1, 2019
McCurtain Memorial Clinic/Valliant HealthcareValliant, OK, CCN 378553 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2021
Apr 1, 2021

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1891341186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 E LINCOLN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747457300",
            "telephone_number": "580-286-7623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8901 N US HIGHWAY 259",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747287086",
            "telephone_number": "580-494-6562",
            "fax_number": "580-494-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC",
        "enumeration_date": "2019-08-13",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCurtain Memorial Urgent Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Bow, OK

Sources for this page

Verify at the official NPI Registry.