1679543581 NPI number — CIMARRON MEMORIAL HOSPITAL AND NURSING HOME

Table of content: (NPI 1306111067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679543581 NPI number — CIMARRON MEMORIAL HOSPITAL AND NURSING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CIMARRON RURAL HEALTH CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679543581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 S ELLIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73933-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-544-2501
Provider Business Mailing Address Fax Number:
580-544-2501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SOUTH ELLIS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73933-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-544-3008
Provider Business Practice Location Address Fax Number:
580-544-3066
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLEASON
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
580-589-0231

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  2254 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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