Blackhawk Mangum LLC
Organization Active NPI Rural Health Clinic/Center · Mangum, OK
NPI 1225362015 · NPPES record last updated Sep 25, 2009
Key facts
- NPI
- 1225362015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BLACKHAWK MANGUM LLC
- Practice address
- One Wickersham Drive
Mangum, OK 73554-9117 - Phone
- (580) 782-3353
- NPI assigned
- Sep 25, 2009
- Organization subpart
- No
Authorized official
- Name
- Jan Winter
- Title
- Ceo
- Phone
- (580) 782-3353
Corporate family (same tax ID) 9
National Provider Directory
- Tax ID family
- Blackhawk Mangum LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
One Wickersham Drive
Mangum, OK 73554-9117
Mailing address
PO Box 280
Mangum, OK 73554-0280
Phone (580) 782-3353
Other names
- Quartz Mountain Medical Clinic Mangum North
Other providers in Mangum, OK
- Bradley Paul Banister
- Martha Barrett
- Robert Telford Bennett
- Russell D Berry
- Blackhawk Mangum LLC
- Blackhawk Mangum LLC
- Blackhawk Mangum LLC
- Blackhawk Mangum, LLC
- Blackhawk Mangum, LLC
- Blackhawk Mangum, LLC
All providers in Mangum, OK · Rural Health Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.