Provider Demographics
NPI:1679543581
Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Entity type:Organization
Organization Name:CIMARRON MEMORIAL HOSPITAL AND NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-589-0231
Mailing Address - Street 1:102 S ELLIS
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-1059
Mailing Address - Country:US
Mailing Address - Phone:580-544-2501
Mailing Address - Fax:580-544-2501
Practice Address - Street 1:102 SOUTH ELLIS
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-1059
Practice Address - Country:US
Practice Address - Phone:580-544-3008
Practice Address - Fax:580-544-3066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIMARRON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2254261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
373459Medicare ID - Type Unspecified